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1 

Nervous  and  Mental  Disease  Monograph  Series  No.  13 

THE  HISTORY  OF 

THE  PRISON  PSYCHOSES 

BY 

DRS.  PAUL  NITSCHE  and  KARL  WILMANNS 

DRESDEN  HEIDELBERG 

AUTHORIZED  TRANSLATION 

BY 

FRANCIS  M.  BARNES,  Jr.,  M.D. 

Senior  Assistant  Physician,  Government  Hospital  for  the  Insane,  and  Instructor  in 

Neurology  and  Psychiatry  in  the  George  Washington  University, 

Washington,  D.  C. 

AND 

BERNARD   GLUECK,  M.D. 

Senior  Assistant  Physician,  Government  Hospital  for  the  Insane, 
Washington,  D.  C. 

WITH   AN   INTRODUCTION 

BY 

WILLIAM  A.  WHITE,  M.D. 


NEW  YORK 

The  Journal  of  Nervous  and  Mental  Disease 

Publishing  Company 

1912 


NERVOUS  AND  MENTAL  DISEASE 
MONOGRAPH   SERIES 

Edited  by 

Drs.  SMITH  ELY  JELLIFFE  and  WM.  A.  WHITE 

Numbeis  Issued 

1.  Outlines  of  Psychiatry.    By  Wm.  A.  White,  M.D. 

2.  Studies  in  Paranoia. 

By  Drs.  N.  Gierlich  and  M.  Friedman 

3.  The  Psychology  of  Dementia  Praecox. 

By  Dr.  C.  G.  Jung. 

4.  Selected  Papers  on  Hysteria  and  other  Psychoneurosee. 

(Second  Edition.)     By  Prof.  Sigmund  Freud. 

5.  The  Wassermann  Serum  Diagnosis  in  Psychiatry. 

By  Dr.  Felix  Plaut. 

6.  Epidemic  Poliomyelitis.    New  York  Epidemic,  1907. 

7.  Three  Contributions  to  Sexual  Theory. 

By  Piof.  Sigmund  Freud. 

8.  Mental  Mechaiisms. 

By  Wm.  A.  White,  M.D. 

9.  Studies  in  Psychiatry. 

New  York  Psychiatrical  Society 
zo.    Handbook  of  Mental  Examination  Methods. 

By  Shepherd  Ivory  Franz. 
n.    The  Theory  of  Schizophrenic  Negativism. 

By  Professor  E.  Bleuler. 

12.  Cerebellar  Functions. 

By  Dr.  Andre-Thomas 

13.  History  of  Prison  Psychoses. 

By  Drs.  P.  Nitsche  and  K.  Wilmanns 


Copyright  1912 

BY 

The  Journal  of  Nervous  and  Mental   Disease 
Publishing   Company 


Press  or 

The  New  era  printini  company 

Lancaster,  Pa 


m 

AOO 


INTRODUCTION 

This  work  brings  the  reader  to  the  present-day  view-points 
with  reference  to  the  prison  psychoses  through  the  medium  of 
a  historical  review  of  their  development  in  the  German  litera- 
ture. Such  a  work  should  be  welcomed  by  all  who  are  interested 
in  the  problems  of  psychopathology  and  particularly  those  who 
long  for  more  rationalistic  methods  of  dealing  with  the  criminal 
and  with  all  of  the  problems  of  criminology. 

The  movement  towards  rationalistic  conceptions  as  opposed 
to  feeling  attitudes  is  an  extremely  slow  one  and  has  hardly  yet 
taken  so  firm  a  rooting  in  this  country  that  an  unfriendly  blast 
might  not  blow  it  away.  Such  a  volume  as  the  present  one, 
therefore,  should  serve  a  distinct  purpose  in  helping  to  fix  atten- 
tion upon  those  concepts  and  methods  that  make  for  a  better 
understanding  of  the  criminal  and  for  more  intelligent  methods 
of  dealing  with  the  many  difficult  problems  that  surround  him. 

How  discouraging  it  is  to  hear  a  magistrate  read  a  sermon 
on  morality  to  some  degraded  wretch  who  has  been  found  guilty 
of  some,  perhaps  minor,  offence,  and  then  send  him  to  prison 
for  the  extreme  limit  prescribed  by  the  statute!  How  pathetic 
if  in  the  procedure  the  judge  should  show  anger  and  resentment! 
How  unintelligent  are  such  exhibitions !  It  is  as  if  a  person  had 
become  ill  from  a  long  course  of  wrong  living,  extending  over 
years,  and  the  doctor  should  dismiss  him  with  a  prescription  for 
a  pill  and  say  not  a  word  about  the  regulation  of  his  life. 

The  criminal  act  which  finally  leads  to  a  prison  sentence  is 
but  the  outcome  of  a  life  of  distorted  view-points,  of  standards 
of  conduct  turned  and  twisted  out  of  all  resemblance  to  those 
with  which  we  are  familiar,  and  to  expect  that  the  natural  prod- 
uct of  such  conditions  can  be  metamorphosed  by  a  three  minute 
sermon  displays  a  profound  ignorance  of  human  beings. 

iii 


iv  INTRODUCTION 

We  may  jump  upon  the  criminal  and,  with  our  knee  upon 
his  chest  and  our  hand  to  his  throat,  choke  the  breath  of  life 
from  his  body.  In  doing  this,  while  we  may  solve  the  difficulty 
so  far  as  he  is  concerned,  we  have  not  touched  the  problem  of 
the  causes  which  created  him  and  which  will  continue  to  create 
others  like  him :  we  have  not  touched  the  problem  of  prevention, 
nor  done  a  single  thing  to  help  matters,  to  assist  at  solution. 
We  have  done  little  else  than  yield  to  a  primitive  passion  for 
revenge,  for  "getting  even";  is  not  that,  to  put  it  mildly,  un- 
intelligent ! 

The  problem  of  the  human  mind,  while  the  most  obvious  of 
all  problems  that  confront  us,  is  the  most  neglected.  Medical 
colleges  are  only  beginning,  haltingly,  uncertainly,  to  introduce 
courses  in  psychopathology.  The  movement  seems  a  long,  long 
way  from  including  the  law  school.  Our  district  attorneys,  far 
from  being  men  with  a  knowledge  of  the  criminal,  are  young 
men  who  seek  the  district  attorney's  office  as  a  good  advertising 
medium  to  enter  practice.  Our  judges,  like  the  district  attor- 
neys, have  only  the  distorted  knowledge  that  comes  from  the 
court  room. 

Let  us  go  to  the  prison  and  talk  with  a  prisoner  who  has  been 
convicted  of  a  serious  offense  against  the  person.  We  find  a  man 
of  apparently  ordinary  intelligence  who  answers  our  questions 
freely  and  in  every  way  acts  like  any  one  else.  Surely  he  should 
be  punished  as  a  warning  to  others !  Let  us  question  him  a  little 
further,  let  us  submit  him  to  a  systematic  mental  examination. 
What  do  we  find?  We  find  him  struggling  desperately,  trying 
over  and  over  again,  to  acquit  himself  creditably  in  answer  to 
our  very  simple  questions.  A  simple  story  is  told  him  and  he 
is  asked  to  repeat  it — not  word  for  word  but  merely  give  the 
sense  of  it,  tell  what  it  was  about.  He  tries  as  hard  as  he  can. 
He  asks  that  the  story  be  repeated,  once,  twice,  and  finally  ac- 
knowledges that  he  can  not  do  it.  He  simply  does  not  know  how 
to  use  his  mind,  he  cannot  fix  his  attention  on  the  thread  of  the 


INTRODUCTION  V 

narration,  he  does  not  know  how  to  grasp  the  essentials  and  lay 
aside  the  unessential.  He  not  only  does  not  know  how  to  use 
his  mind,  but  he  probably  never  knew  he  had  a  mind  before  the 
examination,  even  if  he  knows  it  now.  He  has  lived  a  life  of 
instinct,  of  passion,  of  needs,  desires,  wants,  wishes,  feelings, 
not  of  intellect.  And  his  crime  was  a  crime  of  passion — a  crime 
of  blind  fury.  He  hardly  knows  now  what  he  really  did  except 
perhaps  as  he  has  heard  it  detailed  on  the  witness  stand.  What 
are  your  ideas  now  of  this  creature's  responsibility?  I  can 
hardly  call  him  a  man  for  he  lives  in  a  world  so  simple,  so  crude, 
so  primitive  that  we  are  at  a  loss  to  understand  it.  Shall  we 
take  him  out  of  his  cell  in  the  morning  and  hang  him?  Yes  if 
you  will.  But  don't  do  it  under  any  delusion.  Don't  think 
you  are  helping  solve  the  problem  of  the  criminal.  Don't  even 
think,  for  one  moment,  that  you  are  setting  a  wholesome  ex- 
ample. What  does  he  and  his  ilk  know  of  good  citizenship, 
the  relation  of  the  individual  to  society,  morality  and  such  com- 
plexities. This  man  has  no  imagination,  he  knows  nothing  of 
respect  for  the  law.  He  feels,  he  does  not  think.  And  his  feel- 
ings are  primitive.  He  loves  and  it  is  the  love  of  the  beast,  and 
he  hates,  ah  yes !  and  his  hate  is  the  hate  of  the  beast. 

Pending  the  time  when  all  law  schools  shall  have  courses  in 
the  psychology  of  evidence  and  clinics  in  psychiatry,  as  they  are 
already  beginning  to  in  Europe,  let  us  welcome  this  little  volume 
and  accord  to  the  translators  a  due  measure  of  gratitude  for 
their  work  in  the  service  of  a  good  cause,  for  the  study  of  the 
insane  criminal  is  one  of  the  best  approaches  to  an  understanding 
of  him  as  a  study  of  the  psychology  of  mental  disease  is  one  of 
the  best  methods  of  approach  to  the  understanding  of  the  normal 
individual. 

Wm.  a.  White. 


TRANSLATORS'  PREFACE 

Among  the  multitudinous  problems  which  modern  times  have 
brought  forth  for  solution,  there  is  probably  none  of  greater  im- 
portance to  society  at  large  than  those  which  concern  the  crim- 
inal classes.  The  questions  which  have  been  raised  in  this  broad 
field  cannot  be  answered  by  the  studious  efforts  directed  along 
any  one  line  of  approach.  However,  to  the  medical  profession 
there  is  undoubtedly  relegated  an  important  role  in  the  solution 
of  certain  phases  of  the  general  problem.  Modern  trends  in  this 
country  are  recognizing  more  and  more  each  day  the  necessity 
of  the  coincident  evaluation  of  mental  ability  and  the  criminal 
act.  To  the  psychiatrist  then,  the  comparatively  large  group  of 
mental  disorders  that  develop  in  association  with  conflicts  with 
the  law  and  imprisonment  must  become  of  relatively  greater  im- 
portance in  proportion  to  the  advancement  of  our  social  system 
in  the  plans  which  it  must  devise  for  the  amelioration  and  bet- 
terment of  existing  means  for  dealing  with  these  classes.  No 
extended  exposition  is  needed  to  emphasize  the  importance  of 
this  group  of  mental  disorders.  Rather  are  the  reasons  obvious. 
Here  we  are  dealing  with  individuals  who  potentially  may  be- 
come public  charges  through  criminal  channels  either  primarily 
because  of  a  frank  attack  of  mental  alienation,  using  the  term  in 
the  narrower  sense,  or  indirectly,  because  their  constitutional 
make-up,  distinctly  and  indubitably  deviating  toward  the  abnor- 
mal, leads  them  into  constant  conflicts  with  the  dictates  of  so- 
ciety. It  is  from  these  classes  that  the  criminal  departments  of 
hospitals  for  the  insane  are  recruited.  From  the  administrative 
custom  of  segregating  these  individuals,  we  may  be  led  to  the 
conclusion  that  they  are  inherently  different  from  the  insane  as 
a  class  so  that  the  important  question  arises :  are  we  dealing 
here  with  insane  persons  such  as  we  usually  see  in  asylums  or 

vii 


Vm  TRANSLATORS     PREFACE 

do  they  constitute  a  separate  class  aside  from  the  fact  of  being 
criminal?  This  is  the  crux  and  constitutes  the  starting  point 
from  which  any  rational  attempt  to  gain  an  understanding  of 
those  mental  disorders  included  under  the  term  "prison  psycho- 
sis" must  be  approached.  However,  it  is  evident,  that  the 
problem  is  not  one  of  scientific,  psychiatric  classification  only. 
Its  ramifications,  because  of  the  position  which  the  insane  crim- 
inal occupies  in  the  community,  extend  into  important  territories 
quite  outside  of  the  domain  of  mental  medicine. 

Those  who  have  had  the  opportunity  to  come  into  close  con- 
tact with  the  criminal  with  mental  disorder  and  as  a  psychiatrist 
to  observe  him,  must  have  noted  that  the  population  of  the  crim- 
inal departments  of  hospitals  for  the  insane  naturally  separate 
into  two  distinct  psychiatric  classes.  On  the  one  hand  we  find 
types  of  mental  disorder  among  criminals  which  in  no  wise  im- 
press us  as  diflfering  from  those  among  the  non-criminal  insane, 
while  on  the  other  we  are  repeatedly  confronted  with  psychotic 
complexes  which  cannot  be  satisfactorily  classed  under  any  of 
the  terms  employed  in  the  characterization  of  recognized  organic 
or  functional  mental  disease  entities.  Those  of  the  first  class 
appear  as  accidental  occurrences  among  a  quite  characteristic 
criminal  group  of  men  and  both  from  the  administrative  and 
medical  standpoint  present  no  new  problems.  This  group  is 
largely  comprised  of  individuals  suffering  from  various  forms  of 
dementia  precox,  who  in  their  career  as  insane  persons,  have 
either  fortuitously  come  within  the  purview  of  the  law,  or  whose 
criminal  acts  have  been  determined  definitely  by  their  insane 
ideas.  However,  those  comprising  the  second  class  show  by  the 
symptomatology  of  the  mental  disorder,  the  unmistakable  evi- 
dences of  a  psychogenetically  evoked  complex,  purely  reactive  in 
nature.  These  psychoses  developing  in  such  individuals  are  to 
be  looked  upon  m.erely  as  the  reactive  manifestations  of  a  par- 
ticularly predisposed  mental  make-up  to  certain  specific  un- 
favorable environmental  conditions.     If  such  is  admitted  to  be 


translators'  preface  ix 

the  case,  are  the  onset,  course,  and  termination  of  these  reactions 
demarcated  sufficiently  definitely  from  other  similar  psychotic 
manifestations  to  justify  their  grouping  under  the  special  noso- 
logic caption  "  prison  psychosis  "  ?  Although  considerable  ma- 
terial has  already  been  gathered  in  this  field  the  question  remains 
an  open  and  contested  one  and  authoritative  exponents  of  both 
sides  are  not  wanting.  From  the  practical  side  the  term  cer- 
tainly is  of  value  in  that  it  emphasizes  the  etiologic  potential  of 
imprisonment  as  a  provocative  agent  in  the  causation  of  out- 
spoken psychotic  states  which  properly  demand  hospital  care. 

As  has  been  said,  the  important  relation  of  crime  to  the  psyche 
is  now  receiving  greater  attention  from  the  penologists  in  this 
country.  Toward  the  furtherance  of  this  study  we  have  thought 
that  nothing  could  be  more  appropriate  than  a  translation  of  the 
excellent  historical  review  of  the  subject  of  the  prison  psychoses 
by  Wilmanns  and  Nitsche.  They  have  thoroughly  covered  this 
field  from  the  time  of  the  pioneer  publication  of  Delbriick  down 
to  the  present.  While  Wilmanns  and  Nitsche  have  considered 
exclusively  the  German  literature  their  work  does  not  on  this  ac- 
count sufifer  from  lack  of  completeness.  Other  studies  in  this 
field  have  not  taken  into  consideration  the  entire  subject  but 
have  dealt  with  detail  upon  certain  phases  only. 

Inasmuch  as  a  review  of  the  history  of  the  prison  psychoses 
must  of  necessity  cover  a  prolonged  period  of  changing  psychiat- 
ric views  and  trends,  it  becomes  at  once  apparent  that  the  no- 
menclature employed  by  the  several  authors  whose  works  have 
been  taken  into  consideration  in  this  review  might  well  be  con- 
fusing to  the  psychiatrist  of  the  present  day.  Especial  difficulty 
has  been  experienced  in  expressing  satisfactorily  in  a  transla- 
tion the  meanings  of  the  terms  Wahnsinn  and  Verriicktheit. 
This  is  especially  true  because  our  understanding  of  the  mental 
disorders  comprehended  by  these  terms  has  passed  through  many 
developmental  stages  during  the  past  several  decades,  while  the 
many  discussions  and  controversies  have  succeeded  in  enhancing 


X  TRANSLATORS     PREFACE 

the  difficulties.  Therefore,  in  order  to  make  as  clear  as  possible 
to  the  reader  what  meanings  have  been  given  these  terms  in  this 
translation,  a  few  words  of  explanation  regarding  their  history- 
may  not  be  out  of  place  here.  Verriicktheit,  in  colloquial  Ger- 
man, meaning  only  insanity  without  differentiation,  was  first 
used  (1845)  by  Griesinger  in  the  sense  of  an  incurable,  secondary 
mental  affection,  was  looked  upon  later  as  equivalent  to  the  mon- 
omania of  Esquirol,  was  still  later  by  Kraepelin  considered  as 
synonymous  with  his  paranoia  and  by  some  as  the  equivalent  of 
the  delire  chronique  of  Magnan.  Griesinger  also  recognized  a 
partial  (corresponding  to  the  delire  partiel  of  the  French)  and 
a  general  allgemeine  Verriicktheit  (a  general  confusion  of  ideas 
passing  into  an  actual  dementia).  These  last  two  divisions 
have  been  used  by  Kohler,  whose  paper  is  reviewed  in  this  work 
(p.  12).  Subsequently,  Shell  employed  the  term  Wahnsinn  to 
express  what  Griesinger  had  understood  by  Verriicktheit.  At 
first  then,  both  terms  appear  synonymous  but  later  each  came  to 
convey  a  particular  meaning  as  set  forth  by  Kirn.  Kirn  main- 
tained that  the  difference  between  the  two  terms  was  one  of  prog- 
nostic character,  that  Wahnsinn  was  curable  while  Verriicktheit 
was  incurable  and  therefore,  he  objected  to  the  proposal  of  Wer- 
ner to  adopt  the  term  paranoia  to  include  both  of  these  as  in- 
different. 

The  term  primare  Verriicktheit  (Wille,  Meynert),  indicating 
a  truly  primary  mental  disorder  without  deterioration,  is,  so 
far  as  nomenclature  is  concerned,  practically  the  equivalent  of  the 
mania  or  melancholia  of  the  older  writers. 

It  is  evident  from  the  foregoing  brief  historical  sketch  that  we 
have  nothing  in  our  present  psychiatric  terminology  that  will 
exactly  coincide  or  adequately  express  in  every  instance  the 
fineness  of  differentiation  once  implied  by  these  German  terms. 
We  have  therefore  used  the  word  paranoia  and  also,  here,  as 
well  as  in  many  other  somewhat  similar  difficulties,  have  left  the 
original  term  in  parenthesis  in  order  to  avoid  any  misunderstand- 
ing in  so  far  as  this  may  be  possible. 


translators'    preface  XI 

In  conclusion,  the  translators  take  this  opportunity  of  ex- 
pressing to  Doctors  Nitsche  and  Wilmanns,  appreciation  of  their 

kindness  in  authorizing  this  translation. 

F.    M.    B.,   Jr. 

B.  G. 

Washington,  D.  C, 
April  II,  1912. 


CONTENTS 

Page. 

First  Period   i 

Second  Period 36 

Third  Period 44 

Conclusions  71 

References 83 


THE  HISTORY  OF  THE  PRISON  PSYCHOSES 


FIRST  PERIOD 

When  the  penal  institution  at  Halle  was  founded  in  1842,  it 
was  immediately  filled  with  inmates  from  the  overcrowded  insti- 
tutions in  Spandau  and  Lichtenberg,  and  when  ten  years  later 
considerable  changes  in  the  buildings  had  been  made  it  served 
again  for  the  relief  of  the  new  prison  in  Berlin.  Naturally 
these  institutions  availed  themselves  of  this  favorable  opportu- 
nity to  rid  themselves  of  their  most  troublesome  element  and  the 
result  was  that  the  institution  at  Halle  in  the  middle  of  the  fifties 
contained  within  its  walls  a  number  of  convicts  from  the  old 
provinces  who  were  not  amenable  to  discipline. 

The  most  troublesome  inmates  of  penal  institutions  are  those 
suffering  either  from  obvious  or  unrecognized  mental  disorders 
and  it  is  easy  to  understand  that  the  prison  at  Halle  gradually 
held  a  disproportionately  large  percentage  of  these.  The  fre- 
quency of  mental  disturbance  among  the  inmates  was  at  last  so 
great  that  it  attracted  the  attention  of  the  authorities  and  the 
question  was  raised:  whether  the  cause  did  not  perhaps  lie  in 
the  system  of  punishment  prevailing  at  Halle,  especially  in  the 
frequency  of  solitary  confinement. 

The  criticisms  directed  against  this  penal  system  caused  the 
physician  of  that  institution,  the  elder  Delbriick,  to  consider  in 
his  annual  report  for  1853  the  reasons  for  the  frequency  of 
mental  diseases  among  those  inmates  under  his  supervision  and 
incidentally  for  the  first  time  in  Germany,  to  describe  in  a  thor- 
ough manner  the  relation  between  mental  disturbance  and  crime. 
Thus  originated  the  first  German  work  concerning  the  prison 
psychoses. 


2  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

The  institution  at  Halle  was  only  intended  for  those  guilty 
of  grave  crimes  who  were  to  serve  a  penitentiary  sentence  of  at 
least  five  years.  Most  of  the  inmates,  on  an  average  numbering 
from  eight  hundred  to  one  thousand,  were  recidivists,  guilty  of 
crimes  against  property,  and  from  a  fifth  to  a  fourth  were  guilty 
of  crimes  against  the  person.  The  latter  especially  revealed  a 
pronounced  tendency  toward  mental  disorder  and  among  the 
fifty-eight  insane  whom  Delbriick  observed  in  the  course  of  a 
year,  there  were  23,  /.  e.,  more  than  one  third,  belonging  to  this 
class.  Among  the  insane  who  were  guilty  of  deeds  of  violence, 
those  who  had  made  attempts  against  life  (murder  and  man- 
slaughter) were  especially  numerous ;  one  fourth  of  the  insane 
criminals  belonged  to  this  group,  while  they  only  constituted  a 
sixteenth  of  the  total  number  of  inmates.  This  remarkable  pro- 
portional relation  between  the  number  of  the  insane  guilty  of 
crimes  against  property  and  those  guilty  of  deeds  of  violence, 
had  a  decided  effect  on  the  views  of  Delbriick  concerning  the  re- 
lation of  mental  diseases  to  crimes  against  property  on  the  one 
hand,  and  to  deeds  of  violence  on  the  other,  although  the  ques- 
tion remained  undecided  how  far  this  proportion  might  be  re- 
garded as  purely  accidental. 

In  regard  to  the  relation  between  mental  disturbances  and 
crimes  against  the  person,  Delbriick  teaches  that  the  cause  of 
the  crime  may  be  found  in  the  mental  disturbance  either  during 
its  developmental  period  or  after  it  had  reached  its  heighth.  But 
on  the  contrary,  the  deed  of  violence  with  its  immediate  conse- 
quences might  be  the  reason  for  the  development  of  the  psycho- 
sis. According  to  Delbriick  the  cause  of  the  breakdown  lies 
partly  in  the  long  duration  of  the  imprisonment,  which  is  often 
for  life.  The  principal  reason,  however,  is  to  be  found  in  the 
circumstance,  that  deeds  of  violence  are  preferably  committed 
by  those  of  good  reputation  (of  the  twenty-three  who  had  com- 
mitted deeds  of  violence,  thirteen  were  of  good  reputation),  by 
still  uncorrupted  and  honor-loving  men,  often  against  their  will 


FIRST   PERIOD  3 

and  intention,  during  a  fit  of  passion.  This  sort  of  person  is 
much  more  deeply  afifected  than  the  habitual  criminal  by  the 
repentance  for  the  deed  and  the  regret  for  the  loss  of  honor  and 
freedom.  Aside  from  this  the  character  of  the  crime  itself  must 
be  considered,  for  the  thought  of  having  murder  on  one's  con- 
science as  a  rule  affects  the  mind,  even  of  the  most  corrupt  crim- 
inals, more  deeply  and  lastingly  than  any  other  punishable  act. 

Therefore,  according  to  Delbriick,  the  mental  disturbances 
of  those  who  have  committed  deeds  of  violence,  occupy  a  special 
position  clinically.  All  the  cases  in  which  the  crime  with  its  im- 
mediate consequences  appears  clearly  as  the  cause  of  the  later 
disease,  have  certain  peculiarities  in  common :  the  fixed  ideas  and 
insane  notions  begin  to  develop  as  a  rule  in  the  first  years  of  im- 
prisonment and  betray  an  inner  connection  with  the  crime  com- 
mitted. The  prisoners  have  a  tendency  to  entirely  deny  the 
crime,  or  to  extenuate  it,  or  to  delude  themselves  with  the 
idea  of  an  immediate  return  to  freedom  or  the  injustice  of  their 
imprisonment.  The  origin  of  the  disease  may  be  recognized 
from  its  character,  by  the  deep  and  lasting  emotional  upheaval, 
the  incessant  occupation  of  the  despairing  soul  with  this  one  sub- 
ject, the  restless  but  useless  effort  to  escape  the  torments  of  the 
court  and  the  persecution  of  an  avenging  justice,  the  unsatisfied 
longing  for  freedom  and  former  happy  conditions.  If  the  dis- 
ease continues  for  a  long  time,  as  a  rule  little  trace  of  the  mighty 
shock  which  the  emotions  have  experienced  remains.  "  The 
process  which  produced  the  insanity  is  exhausted,  the  insanity 
continues  but  the  powers  of  the  emotions  are  dead." 

Delbriick's  views  concerning  the  relation  between  mental 
disturbances  and  crime  in  the  case  of  those  guilty  of  crimes 
against  property,  that  is  to  say  the  habitual  criminal,  are  entirely 
different.  Here  likewise,  the  mental  disturbance  may  be  the 
cause  of  the  crime,  although  by  far  not  so  frequently  and  not  so 
unequally  as  is  the  case  with  the  criminal  by  passion.  But  in 
those   guilty   of   crimes   against   property,   in   contrast   to   those 


4  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

guilty  of  crimes  of  violence,  it  is  a  rare  exception  that  the  crime 
in  itself  is  the  cause  of  the  mental  disturbance.  If  a  recidivist 
guilty  of  crimes  against  property  develops  a  psychosis,  the  cause 
lies  in  the  long  term  sentence,  but  that  in  itself,  however,  has  a 
less  harmful  effect  on  the  health  than  the  contrast  between  free- 
dom and  imprisonment,  the  hopelessness  and  the  painful 
thought  of  being  deprived  of  freedom  forever,  or  at  least,  for  a 
long  time.  The  main  reason,  however,  for  the  later  development 
of  mental  disturbance  in  those  guilty  of  crimes  against  property, 
is  to  be  sought  in  the  past  career  of  the  criminal.  The  great  ma- 
jority of  them  began  their  careers  of  crime  in  their  earliest 
youth,  many  even  as  boys.  They  grew  up  in  poverty  and  with- 
out supervision,  were  affected  by  evil  tendencies  and  vice  from 
youth  or  yielded  to  drunkenness  and  sexual  excesses  of  various 
sorts,  passed  a  large  part  of  their  lives  in  prisons,  penitentiaries, 
almshouses  and  correctional  institutions;  in  short  they  led  in 
every  respect  a  dissolute  and  irregular  life,  which  must  have  at 
the  same  time  acted  deleteriously  upon  their  morality  as  well  as 
their  physical  and  mental  health.  That  such  a  career  often  fur- 
nishes the  proper  soil  for  the  development  of  a  mental  disturb- 
ance seems  to  Delbriick  a  just  supposition. 

Delbriick  defends  this  view  in  a  work  which  appeared  three 
years  later,  wherein  he  seeks  to  sustain  his  theory  by  two  thor- 
oughly described  cases  of  progressive  psychoses,  of  paranoia  of 
the  criminal  (Verbrecherwahnsinn)  as  he  calls  the  disease.  Both 
cases  have  this  feature  in  common,  that  in  the  course  of  time  the 
insane  and  delusional  ideas  brought  about  a  situation  completely 
the  opposite  of  the  actual  circumstances.  The  criminal  con- 
sidered himself  innocent  and  the  representatives  of  justice  the 
real  criminals.  According  to  Delbruck's  view  they  differed  from 
one  another  in  that  in  one  case  the  only  criminal  deed  in  his  life 
appeared  as  the  essential  cause  of  the  insanity,  determined  the 
nature  of  the  disease,  and  the  content  of  the  delusions;  while  in 
the  other,  an  old  habitual  criminal,  the  disease  showed  less  the 


FIRST    PERIOD  5 

stamp  of  a  single  deed  than  of  the  criminal  habit  which  had  be- 
come a  second  nature  to  him. 

Delbriick,  therefore,  believed  to  have  found  in  his  paranoia 
of  the  criminal  (Verbrecherwahnsinn),  a  characteristic  disease, 
which  was  sharply  demarcated  from  the  forms  of  insanity  to 
which  those  living  in  freedom  are  subject.  If  the  onset  of  the 
disorder  takes  place  prior  to  the  crime,  or  if  the  relation  between 
the  crime  and  the  psychosis  is  only  a  coincident  one,  these  mental 
disturbances  are  not  essentially  different  from  those  in  ordinary 
life.  In  these  cases  even  though  the  crime  and  the  imprisonment 
may  influence  the  further  development  of  the  disease,  and  grad- 
ually lend  to  it  a  coloring  resembling  that  of  the  paranoia  of  the 
criminal  (Verbrecherwahnsinn),  this  delusional  reversal  of  con- 
ditions, in  which  the  criminal  thinks  himself  wholly  blameless  and 
that  honorable  people  only  imagine  his  crimes  and  vices,  does  not 
exist,  according  to  Delbriick.  Ideas  of  the  illegality  of  their  sen- 
tence, of  unlawful  treatment,  unjust  continuation  of  the  impris- 
onment, and  incessant  accusations  and  complaints  against  justice 
and  prison  officials  and,  in  consequence  of  this,  the  idea  of  mar- 
tyrdom, he  also  found  in  these  criminals. 

The  two  essays  of  Delbriick's  were  at  first  the  only  works  on 
this  subject  until  1862  when  Gutsch,  a  physician  in  the  peniten- 
tiary founded  at  Bruchsal  in  1848,  published  his  twelve  years'  ex- 
perience concerning  mental  disturbances  in  solitary  confinement. 

Similarly  to  Delbriick,  Gutsch  divides  the  causes  of  the  dis- 
ease into  two  classes,  those  connected  with  the  crime,  sentence 
and  punishment,  and  the  various  factors  which  lie  beyond  the 
imprisonment.  Gutsch  assumes  as  proven  that  the  crime  in  it- 
self, the  conviction  and  punishment  predispose  to  mental  dis- 
turbance and  confirms  Delbriick's  view  that  the  conviction  and 
imprisonment  have  a  more  intensive  effect  when  the  crime  arises 
from  uncontrolled  emotions  and  an  ill-regulated  life,  where  vice 
and  moral  depravity  have  exercised  a  destructive  influence  on 
mind  and  body.     Furthermore,  according  to  the  experience  of 


6  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

the  prison  physician  at  Bruchsal,  grave  offences  against  the  per- 
son especially  predisdose  to  mental  disease.  The  more  infre- 
quent crimes  of  murder,  manslaughter,  high  treason,  mutiny,  in- 
subordination, desertion,  plunder  and  sexual  offences,  produce 
mental  disturbances  much  more  frequently  than  the  more  fre- 
quent crime  of  theft.  Likewise  the  impulsive  crimes,  the  results 
of  strong  affects  of  every  sort  upon  the  temper  and  emotions,  pre- 
dispose more  to  mental  disease  than  habitual  ones,  which  are  the 
result  of  the  development  of  a  deep  seated  depravity. 

Gutsch  also  believed  himself  justified  in  regarding  deficient 
education  as  a  factor  favorable  to  the  development  of  mental 
disturbance,  and  explains  this  by  assuming  that  the  educated 
endure  the  imprisonment  better  because  they  know  how  to  em- 
ploy themselves,  while  the  uneducated  and  mentally  weak  are 
more  susceptible  to  the  dangers  of  ennui  and  depressing  emo- 
tions. Gutsch  was  led  to  this  conclusion  by  the  facts  statistic- 
ally established,  that  among  the  uneducated  inmates  of  Bruch- 
sal, 3.3  per  cent,  acquired  mental  disease,  while  among  the  edu- 
cated only  1.08  per  cent.  But  he  forgot  in  this  connection  that 
the  educated  inmates  of  the  penitentiaries  (1848)  were  mostly 
political  prisoners  who  were  vastly  superior  to  those  guilty  of 
crimes  against  property  not  only  in  education,  but  above  all,  in 
mental  vigor. 

Gutsch  ascribes  a  much  greater  importance  to  certain  somatic 
influences  associated  with  the  penitentiary  life.  The  weakening 
and  inactivity  of  the  reproductive  life,  of  the  animal  and  vital 
functions  in  the  prisoners'  physical  organization,  the  predomi- 
nance of  apathy  and  passivity  which  are  the  unavoidable  attri- 
butes of  every  form  of  imprisonment  and  every  penal  system. 
It  is,  therefore,  easily  comprehensible  that  the  sense  of  debilita- 
tion and  loss  of  power  must  produce  a  subjective  feeling  of  in- 
creased susceptibility  to  disease,  at  least  a  mental  discord,  aside 
from  any  really  abnormal  disturbance  which  may  contain  the 
germ  of  more  serious  disorders.     Gutsch  believes  that  he  can 


FIRST   PERIOD  7 

confirm  the  expectation,  that  during  the  intensification  of  pun- 
ishment, particularly  during  imprisonment  in  darkness  with  dim- 
inution of  food,  these  psychic  and  somatic  factors  may  attain 
a  greater  influence  and  may  lead  to  an  increase  in  the  number 
of  psychoses.  During  the  years  from  1853  to  1857,  when  these 
disciplinary  punishments  were  prescribed  all  too  frequently  by 
the  courts,  a  distinct  increase  in  the  number  of  mental  diseases 
was  noticeable.  But  because  in  these  years  there  was  a  strong 
influx  of  prisoners  from  the  general  prisons  of  the  country,  who 
were  weakened  by  their  long  terms  of  imprisonment,  these  sta- 
tistics do  not  establish  the  view  of  Gutsch,  though  it  is  in  itself 
a  proper  one. 

In  addition  to  these  general  causes  here  mentioned,  Gutsch 
makes  special  individual  causes  responsible  for  the  development 
of  mental  disturbances,  such  as  epilepsy,  heredity,  the  degree  of 
mental  capacity,  eccentricity,  passion,  brutality,  irascibility,  peri- 
odic conditions  of  excitement  and  irritability,  changeableness  of 
temper,  exaltation,  pride,  self-conceit  in  the  poorly  educated,  re- 
ligious phantasy,  superstition,  belief  in  dreams,  etc. 

Delbriick  had  already  given  prominence  to  the  fact  that  a  pro- 
longed absolute  isolation  has  a  very  injurious  effect  on  the  body 
and  mind  and  that  it  seems  to  predispose  to  hallucinations,  as  does 
the  seclusion  of  prison  generally.  He  advised  the  immediate 
termination  of  solitary  confinement  in  all  cases  where  its  dele- 
terious effects  upon  the  emotions  were  noted,  and  the  substitution 
for  it  of  a  treatment  as  far  as  possible  in  contrast  to  it.  This  was 
considered  to  be  the  surest  means  of  averting  the  disorder,  or 
checking  it  in  its  incipiency.  Gutsch  who  in  the  course  of  an 
experience  of  twelve  years  among  three  thousand  prisoners,  gath- 
ered a  great  many  observations  upon  the  effects  of  solitary  con- 
finement, substantiates  Delbriick's  views.  He  accentuates  espe- 
cially the  influence  of  solitary  confinement  upon  the  emotional 
life  of  man  and  holds  isolation  largely  responsible  for  the  frequent 
outbreaks  of  mental  disturbance.     Its  effect  is  srreater  the  more 


8  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

irreproachable  the  previous  life  of  the  convict  has  been,  but  even 
in  old  criminals  it  causes  a  change  of  personality.  These  emo- 
tional shocks,  as  Gutsch  designates  the  reactions  of  the  psyche  to 
solitary  confinement,  can  not  be  likened  to  that  sadness  and 
dejection  which  always  accompanies  the  change  from  freedom  to 
imprisonment;  this  is  also  found  in  mass  imprisonment.  Here 
one  has  to  deal  with  an  emotional  effect  evoked  by  the  self- 
contemplation  due  to  being  alone — the  deepest  expression  of  an 
intense  tumult  in  the  emotions  of  the  isolated  prisoner.  The 
emotional  shock  must  often  be  hailed  as  the  turning  point  towards 
reform  in  the  life  of  the  prisoner,  but  at  the  same  time  it  fur- 
nishes the  transition  between  mental  health  and  disease,  and  em- 
phasizes the  dangerous  side  of  solitary  confinement.  Delbruck 
gave  his  special  attention  to  only  a  small  number  of  chronically 
insane  inmates  of  the  prison  at  Halle.  The  remainder  he  does  not 
mention  in  his  work,  and  there  is  no  doubt  but  that  he  overlooked 
or  failed  to  recognize  a  large  number  of  cases,  especially  those  of 
only  temporary  mental  disturbance.  Gutsch's  work  is  an  advance 
in  this  respect,  as  he  considers  all  cases  which  came  under  his 
observation  between  the  years  of  1850  and  1862.  He  likewise 
endeavored  to  render  more  accurate  reports  concerning  the  prog- 
nosis of  the  cases  studied  by  him,  and  sought  for  this  purpose 
more  thorough  knowledge  in  the  homes  of  the  discharged  prisoners. 
The  material  which  furnished  the  basis  for  Gutsch's  views 
consisted  of  eighty-four  cases  of  mental  disorder  which  developed 
in  solitary  confinement  between  1846  and  i860.  These  cases 
were  stamped  by  their  common  etiologic  factor  with  a  homo- 
geneous seal.  The  similarity  of  the  recurring  attacks  of  emo- 
tional and  depressive  shocks,  of  religious  and  agitated  melancholia, 
of  a  tendency  to  suicidal  and  maniacal  outbreaks,  of  homesickness, 
and  of  the  frequent  idea  of  having  been  pardoned,  shows  unmis- 
takable features  of  a  common  origin.  The  frequent  belief  in  a 
sustained  injustice,  in  lesser  guilt  or  even  innocence,  the  suspi- 
cion, hatred  and  disgust  retained  from  the  time  of  the  trial,  trans- 


FIRST    PERIOD  9 

fer  themselves  to  the  conditions  of  prison  and  develop  not  infre- 
quently under  the  favorable  influence  of  solitary  confinement  into 
pathologic  delusions.  They  evidence  themselves  in  hallucinations 
and  delusions  of  persecution,  of  poisoning,  deal  with  the  injustice 
of  continued  confinement,  and  manifest  themselves  in  an  insane 
rebellion  against  the  prison  routine.  Because  of  all  these  symp- 
toms common  to  the  disturbances  developing  in  prison,  these  cases 
assume  a  strong  outward  similarity.  This  similarity,  however, 
goes  still  further,  and  applies  even  to  the  outbreak  of  the  dis- 
order, because  according  to  Gutsch's  observations  one  of  the  most 
prominent  characteristics  of  the  psychoses  developing  in  solitary 
confinement  is  that  delusional  ideas  do  not  attach  themselves 
immediately  to  the  varied  emotional  disturbances,  but  that  the 
psychosis  frequently  sets  in  with  auditory  hallucinations  or  isolated 
delusions  without  any  other  premonition.  According  to  his 
description  there  immediately  occur  in  most  cases  auditory  hallu- 
cinations of  -a  mocking,  derisive,  provoking  and  sometimes  of 
promising  content.  More  rarely  isolated  delusions,  such  as  poi- 
soning, persecution,  and  chicanery  on  the  part  of  the  overseers 
develop  first,  and  provoke  more  marked  changes  of  mood  and 
behavior.  In  all  cases,  however,  there  develops  the  unalterable 
conviction  of  the  genuineness  of  the  hallucinatory  and  delusional 
experiences,  apprehensiveness  and  restlessness,  irritability  or  ex- 
citement and  insomnia.  According  to  the  predominating  affect- 
tone  and  further  development  of  the  disorder,  Gutsch  divides  his 
eighty-four  cases  into  affective  disorders,  that  is,  mania  and  mel- 
ancholia, and  disorders  of  the  intelligence,  as  paranoia  (Wahnsinn 
and  Verriicktheit)  and  dementia  (Blodsinn).  The  majority  of 
the  eighty-four  cases,  namely  fifty-eight,  Gutsch  designates  as 
melancholia,  and  again  subdivides  these  and  groups  a  large  num- 
ber (32)  under  the  name  of  melancholia  of  slight  degree.  In 
these  the  undoubted  manifestations  of  psychic  disorder  which 
attached  themselves  to  the  depressive  mood  remained  isolated,  or 
manifested  themselves  only  periodically  or  temporarily  without 


10  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

developing  into  a  higher  form.  All  of  them  made  complete  re- 
coveries upon  removal  from  solitary  confinement  or  the  termi- 
nation of  imprisonment.  These  melancholias  comprise,  according 
to  Gutsch,  aside  from  the  few  cases  of  acute  and  transitory  con- 
fusion accompanied  by  emotional  shock,  especially  those  forms 
characteristic  of  solitary  confinement,  in  which  the  suddenly  devel- 
oping hallucinations  of  hearing  and  delusions  remain  isolated  and 
restricted.  They,  however,  deserve  great  consideration  because 
of  the  ease  of  their  development,  and  because  they  frequently 
form  the  initial  stages  of  graver  disorders,  though  not  possessing 
characteristics  of  complete  psychoses.  Because  of  the  high  per- 
centage of  recoveries  among  cases  of  melancholia,  Gutsch  con- 
siders that,  as  a  general  rule,  the  prognosis  of  the  psychosis  de- 
veloping in  solitary  confinement  is  extremely  favorable.  The 
inquiries  concerning  the  discharged  patients  showed  that  a  great 
majority  of  them  remained  permanently  cured.  Gutsch,  there- 
fore, thinks  the  belief  that  certain  cases  having  a  mild  beginning 
may  contain  the  nucleus  for  the  development  of  a  later,  graver 
disorder,  entirely  unfounded.  Thus  solitary  confinement  itself 
furnishes  a  strong  predisposition  for  the  development  of  mental 
disorder.  At  the  same  time,  however,  it  aflfords  the  ability  to 
recognize  these  mental  disorders  in  their  earliest  stages,  so  that 
in  the  majority  of  cases,  lasting  after-effects  can  be  prevented  by 
timely  interference. 

Gutsch's  collective  descriptions  are,  in  contradistinction  to 
those  of  Delbriick,  deficient  in  clearness,  accuracy  and  complete- 
ness ;  they  take  into  practical  consideration  the  content  of  the 
delusions  and  hallucinations,  but  they  leave  us  more  or  less  com- 
pletely in  the  dark  concerning  the  emotional  state,  the  orientation 
for  time  and  place,  the  state  of  consciousness,  insight,  etc.  Never- 
theless, at  that  time,  the  superintendent  of  Illenau,  Roller,  was 
convinced  from  Gutsch's  exposition,  of  the  existence  of  a  charac- 
teristic form  of  melancholia  with  auditory  hallucinations  which 
was  due  to  solitary  confinement  and  which  as  a  rule  immediately 


FIRST   PERIOD  II 

subsided  upon  the  transfer  of  the  patient  to  mass-imprisonment. 
Even  he,  however,  did  not  obtain  a  clear  picture  of  this  prison 
psychosis,  and  expressed  the  wish  that  Gutsch  had  furnished  more 
detailed  information  concerning  the  state  of  consciousness  during 
and  after  these  attacks,  and  concerning  the  coexisting  physical 
and  psychic  states.  This  desire  remained  unfulfilled.  Delbriick, 
on  the  contrary,  again  took  the  opportunity  to  report  his  further 
experience  with  mental  disorders  in  criminals.  He  adhered  in  the 
main  to  his  former  views.  The  cause  of  the  development  of  a 
psychosis  in  the  offender  against  property  lies  mainly  in  his  former 
life.  In  the  criminal  by  passion,  on  the  other  hand,  the  crime 
itself  and  its  immediate  results  are  the  chief  etiologic  factors.  He 
especially  opposed  Gutsch's  views  that  the  psychoses  described  by 
the  latter  are  characteristic  of  solitary  confinement.  He  himself 
met  with  such  mental  disorders  in  solitary  confinement  but  he  also 
observed  them  just  as  frequently,  if  not  oftener,  in  mass-impris- 
onment. Delbriick  doubts  above  all  Gutsch's  assertion  of  the 
frequency  of  the  acute  onset  of  these  cases.  He  believes  that 
only  in  rare  instances  does  a  previously  healthy  individual  sud- 
denly develop  a  severe,  acute  mental  disturbance  which  then  re- 
mains stationary  for  months  and  years,  or  quite  rapidly  becomes 
absolutely  incurable.  Much  more  frequently  there  first  develop 
periodic,  mild  indications,  then  the  real  attacks  become  evident, 
and  often  disappear  again  after  a  few  days  or  weeks.  The  attacks 
repeat  themselves  in  shorter  or  longer  periods,  there  are  years 
during  which  they  are  of  frequent  and  significant  occurrence, 
then  again  years  when  they  completely  disappear,  but  sooner  or 
later  the  attacks  come  closer  together,  their  duration  becomes  more 
and  more  prolonged,  the  lucid  intervals  progressively  shorter,  and 
they  leave  behind  more  or  less  significant  residuals,  until  finally 
the  disease  assumes  larger  proportions  and  becomes  permanent 
and  incurable.  In  certain  cases  this  process  may  terminate  in  the 
first  year,  in  others  only  after  ten  or  twenty  years,  or  on  the  other 
hand,  a  spontaneous  and  quite  unexpected  recovery  may  later  set 
in.     To  this  group  belong  half  of  the  insane  criminals. 


12  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

Following  the  studies  of  these  prison  physicians  of  the  prison 
psychoses,  psychiatrists  commenced  to  concern  themselves  with 
the  solution  of  this  problem.  Aside  from  Reich's  important  work 
in  1871,  we  must  consider  those  of  Kohler  and  Sommer.  Kohler 
studied  the  thirty-one  female  convicts  of  the  Hubertusburg  Insane 
Asylum.  Without  going  into  this  work  in  detail,  we  will  simply 
mention  that  he  believed  he  had  found  among  the  cases  studied 
by  him  such  disorders  as  mania,  paranoia  (Wahnsinn,  including 
also  partielle  Verriicktheit  and  allgemeine  Verrucktheit)  and  de- 
mentia (Blodsinn),  which  did  not  occur  well  defined,  but  always 
distorted,  over-shadowed  and  blurred  by  other  disturbances  exist- 
ing simultaneously.  The  indefiniteness  of  these  psychic  forms, 
their  transition  into  other  states,  the  predominance  of  perverted 
emotional  tendencies,  made  any  well  defined  diagnosis  often  im- 
possible. All  of  these  psychic  disease  states,  Kohler  says  in  his 
summary,  are  complicated  by  conditions  and  symptoms  having 
their  roots  in  the  moral  obliquity,  coarseness  and  brutality  of  these 
individuals,  which  distort  and  dim  the  disease  picture  in  the  most 
contradictory  manner.  These  moral  degeneracies  which  have 
been  a  part  of  the  psychoses  from  their  very  incipiency  play  the 
same  role  as  do  the  constitutional  dyscrasias  in  physical  diseases, 
transforming  the  original  disease  beyond  recognition,  and  thus 
they  form  a  particular  species  in  insane  asylums  owing  to  their 
peculiarities.  He  concludes  that  one  would  not  be  far  amiss  in 
designating  them  as  "mania  vesania  criminosa,"  analogously  to 
the  designations  scrofulous  and  syphilitic  in  speaking  of  physical 
disorders. 

Of  much  greater  significance  was  the  other  psychiatric  work, 
"  Contributions  to  the  Study  of  the  Criminal  Insane,"  by  Sommer, 
which  appeared  in  1884.  Sommer  studied  all  the  cases  which 
were  transferred  from  various  prisons  and  penitentiaries  to  the 
insane  asylum  at  Allenberg  during  a  period  of  thirty  years,  in  all 
one  hundred  and  eleven  cases.  The  majority  of  these  cases, 
namely  75  per  cent.,  already  had  the  predisposition  to  mental  dis- 


FIRST   PERIOD  I  3 

orders  because  of  imbecility,  eccentricity  of  manner,  irritability  of 
character,  brutal  impulsive  sensuality,  drunkenness,  brain  concus- 
sions, etc.  Such  a  predisposed  brain  becomes  easily  diseased 
under  adverse  circumstances.  The  crime  itself,  the  excitement 
incident  to  the  act,  the  detection  and  publicity,  the  remorse  and 
regret,  the  worry  about  relatives,  the  sad  outlook  for  the  future, 
the  hopelessness  of  the  situation,  especially  in  long  sentences,  all 
these  along  with  the  suddenly  changed  mode  of  life,  the  curtail- 
ment of  freedom,  the  forced  subjection  to  an  unaccustomed  severe 
discipline,  the  scarcity  of  exercise  and  air,  the  consequent  prison 
anemia,  the  sexual  aberrations,  are  certainly  sufficient  to  unbalance 
a  normal  mind,  how  much  more  easily  therefore  a  mind  that  is 
already  working  abnormally,  one  that  is  accustomed  to  the  routine 
stimulations  of  customary  luxuries  which  are  now  denied  it.  Cer- 
tainly the  punishment  itself  has  a  marked  influence  on  the  mental 
condition  of  the  patient.  Much  greater  importance,  however, 
Sommer  attributed  to  the  kind  of  punishment.  The  inmate  of  a 
reformatory  who  spends  most  of  the  day  in  company  with  other 
prisoners,  or  in  the  open,  and  who  as  a  whole  leads  during  his 
imprisonment  a  more  rational  life  than  that  which  his  poor  home 
surroundings,  or  his  vagabond  existence  afiforded  him,  will  seldom 
develop  a  mental  disorder  as  the  result  of  his  imprisonment. 
Therefore  Sommer  considers  the  development  of  mental  disorders 
in  reformatories  of  very  rare  occurrence,  and  as  a  matter  of  fact, 
of  the  thirteen  cases  of  reformatory  inmates  received  at  Allenberg 
in  the  course  of  thirty  years,  eight  were  definitely  insane  before 
their  conviction,  and  the  remaining  five  were  at  least  very  sus- 
picious cases.  In  contrast,  however,  to  the  workhouse  or  reform- 
atory, the  penitentiary,  with  its  long  term  sentences,  its  solitary 
confinement,  its  hard  labor  and  enforced  mutism,  its  monotonous 
occupation  and  severe  discipline,  its  entire  mode  of  life  favorable 
for  the  development  of  anemia  and  phthisis,  furnishes  greater  op- 
portunity for  the  development  of  mental  disorders.  Accordingly 
the  pentitentiary  furnished  thirty-six  of  the  cases  at  Allenberg, 


14  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

twenty-eight  of  which  developed  mental  disorders  only  after  their 
confinement. 

Just  as  Delbriick  and  Gutsch  had  before  him,  Sommer  came 
to  the  conclusion  that  the  occasional  criminal,  and  the  criminal  by 
passion,  developed  mental  disorders  much  more  frequently,  indeed, 
almost  twice  as  frequently,  as  the  habitual  criminal.  He  attrib- 
utes this  to  the  fact  that  the  criminal  by  passion  feels  the  punish- 
ment more  acutely,  his  entire  mode  of  life  in  prison  being  very 
much  opposed  to  his  demand  upon  life,  and  his  emotional  make-up 
submits  with  much  greater  difficulty  to  the  discipline.  The  ha- 
bitual criminal,  on  the  other  hand,  adapts  himself  more  readily 
to  his  lot.  Sommer  likewise  found,  in  accordance  with  the  former 
authors,  that  the  majority  of  the  insane  criminals  had  long  sen- 
tences, only  twelve  of  his  thirty-six  patients  who  came  from  the 
penilentiaries  had  less  than  a  five  year  sentence.  Three  times  as 
many  of  the  long  term  prisoners  as  of  the  short  term  ones  became 
insane.  Sommer  also  agrees  with  Delbriick  and  Gutsch  that  the 
majority  of  cases  develop  their  mental  disturbances  within  the 
first  two  years  of  imprisonment,  therefore  the  confinement  in  itself 
cannot  be  considered  as  the  cause  of  the  mental  disorder,  but 
rather  its  psychic  effect,  especially  the  contrast  between  liberty 
and  prolonged  imprisonment.  In  his  clinical  views  Sommer  again 
differs  from  the  previous  authors.  His  observations  taught  him 
that  there  is  no  form  of  mental  disorder  among  criminals  which 
takes  a  definite  course  either  constantly  or  even  very  frequently. 
On  the  other  hand,  he  was  of  the  opinion  that  there  exists  a  specific 
psychosis  which  develops  almost  exclusively  in  criminals,  and 
without  any  demonstrable  relations  with  the  nature  and  degree  of 
the  offence.  Vagabonds  with  relatively  short  sentences  are  affected 
with  this  disorder  as  well,  although  not  as  frequently,  as  life  sen- 
tence prisoners.  This  specific  mental  disorder  is  what  he  calls 
"prison  paranoia"  (Gefangnisswahnsinn).  What  Delbriick  de- 
scribes as  the  paranoia  of  criminals  (Verbrecherwahnsinn)  and 
Gutsch  as  the  psychosis  of  solitary  confinement,  are  according  to 


FIRST   PERIOD  15 

Sommer,  nothing  else  than  episodes  of  his  prison  paranoia.  Nearly 
all  the  diseased  states  developing  in  confinement  are  merely  devel- 
opmental stages  of  this  psychosis.  It  matters  not  how  extremely 
varying  their  manifestations,  they  are  in  most  instances  only  to 
be  considered  as  different  phases,  as  abortive  cases  of  this  prison 
paranoia. 

Accordingly,  nearly  all  of  Sommer's  cases  suffered  from  this 
psychosis.  Aside  from  this  disorder,  he  observed  only  a  few 
cases  of  paresis,  alcoholic  mania,  mania,  catatonia,  imbecility, 
epilepsy,  secondary  dementia,  traumatic  insanity  and  paranoia 
(Verriicktheit).  In  a  detailed  description,  Sommer  endeavors  to 
account  in  a  psychological  manner  for  the  origin  and  development 
of  this  progressive  disorder  by  aid  of  theoretical  and  crude  ana- 
tomical conceptions.  He,  too,  does  not  escape  the  danger  of  forc- 
ing symptomatology  to  favor  his  attempts  at  explanation.  Never- 
theless, his  descriptions  mean  a  decided  step  in  advance  of  what 
had  previously  been  said  on  the  subject.  As  the  first  evidence  of 
the  beginning  disorder,  according  to  Sommer,  is  the  strikingly 
changed  manner  and  behavior  of  the  individual.  He  gradually 
becomes  careless  in  his  work  and  is  unable  to  concentrate  his  atten- 
tion upon  it.  Every  now  and  then  he  looks  behind  him  in  an 
astonished  manner,  attentively  listening  to  some  inexplicable  noise. 
These  elementary  disturbances  of  the  sensorium  increase  as  his 
working  capacities  diminish.  The  patient  becomes  uncertain,  de- 
pressed, irritable,  suspicious.  From  these  new  conflicts  with  his 
environment  constantly  arise,  in  vain  he  seeks  an  explanation  for 
this  mysterious,  inexplicable  change  in  his  situation,  he  sinks  into 
an  apathetic  brooding,  is  painfully  affected  by  unpleasant  bodily 
sensations,  and  perplexedly  faces  the  indefinite  illusions  and  hallu- 
cinations. Thus  the  first  stage  of  the  disorder  is  reached,  the 
state  of  perplexity.  As  long  as  the  disease  has  progressed  no 
further,  as  long  as  the  hallucinations  remain  elementary  in  char- 
acter, Sommer  deems  improvement  or  complete  cure  possible. 
This  first  stage,  which,  as  a  rule,  is  accompanied  by  a  sad  and 


1 6  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

anxious  affect-tone,  is  what  former  writers  usually  described  as 
melancholia.  Sommer,  however,  considers  this  but  a  stage  in  the^ 
development  of  his  prison  paranoia,  which  reaches  its  full  devel- 
opment so  much  the  more  certainly  as  the  injurious  effects  of 
imprisonment  continue  active.  The  hallucinations  become  more 
numerous ;  auditory,  visual,  and  olfactory  hallucinations  set  in^ 
and  various  sexual  sensations  develop.  Disciplinary  measures 
strengthen  the  prisoner's  belief  in  his  false  persecutions  and  de- 
nunciations, the  mental  enfeeblement  progresses  rapidly,  frequent 
excitements  and  vicious  assaults  occur,  and  are  again  met  with 
disciplinary  measures,  until  finally  the  disease  is  recognized.  Si- 
multaneously with  this,  the  deleterious  transition  from  fleeting  and 
changeable  delusions  into  fixed  and  systematized  ones  takes  place. 
An  unshakable  delusional  system  has  been  elaborated.  His  prison 
paranoia  is  fully  developed.  During  this  stage  the  fallacious  sen- 
sory perceptions  spread  to  other  sensory  fields.  They  become 
more  and  more  distinct,  and  attach  themselves  to  the  all  domi- 
nating persecutory  ideas.  In  this  stage  only  temporary  improve- 
ment is  possible.  Complete  recovery,  however,  is  out  of  the  ques- 
tion. Gradually  there  develop  grandiose  ideas,  which  according 
to  Sommer  evolve  in  a  psychologic  manner  from  the  persecutory 
and  prejudicial  delusions.  Simultaneously  with  this  the  patient's 
conduct  becomes  quieter,  he  returns  to  work,  and  interrupts  his 
occupation  only  long  enough  to  show  by  means  of  mysterious 
grimaces  and  inexplicable  gesticulations  his  outcropping  grandiose 
delusions.  The  excited  outbursts  which  occur  during  this  stage 
of  the  disorder  differ  from  similar  manifestations  of  other  insane 
people  in  their  striking  want  of  consideration  for  persons  and 
objects.  Also,  the  gradual  transition  of  the  disorder  into  con- 
fusion and  dementia  offers  nothing  characteristic ;  this  is  liable  to 
occur  in  his  prison  paranoia  sooner  and  in  a  more  pronounced 
manner  than  in  ordinary  insanity.  Such  is  Sommer's  prison  para- 
noia (Gefangnisswahnsinn)  from  which,  according  to  him,  the 
majority  of  insane  criminals  suffer.     Though  this  prison  psychosis 


FIRST   PERIOD  1/ 

is  a  specific  mental  disturbance  of  prisoners,  its  characteristic 
coloring,  however,  need  not  be  considered  as  proof  of  the  causal 
relations  between  confinement  and  mental  aberration ;  the  origin 
of  the  disorder  is  to  be  looked  for  in  the  previous  history  of  the 
criminal.  Confinement  in  itself  influences  only  the  symptoma- 
tology. It  does  not  evoke  the  disorder  itself  but  determines  its 
form. 

To  Sommer  belongs  the  credit  of  having  shown  more  accurately 
than  Delbriick,  and  especially  Gutsch,  the  similarity  of  the  great 
number  of  the  psychoses  developing  in  prison.  His  description 
itself,  however,  no  matter  how  correctly  the  individual  symptoms 
may  have  been  delineated,  is  an  inaccurate  one  because  of  the 
forced  schematization  with  which  Sommer  endows  it. 

Quite  a  few  years  before  the  appearance  of  Sommer's  work 
there  were  published  two  smaller  dissertations  on  this  subject,  both 
by  prison  physicians.  Knecht  published  in  1891  his  experiences 
in  the  insane  department  of  the  prison  at  Waldheim,  and  reported 
data  concerning  the  one  hundred  and  sixty-eight  inmates  of  that 
institution.  He  substantiates  the  views  of  his  predecessors  that 
the  frequency  of  mental  disturbances  in  prisoners  is  in  direct  pro- 
portion to  the  gravity  of  the  crime  and  the  length  of  the  conse- 
quent sentence,  that  the  majority  of  the  patients,  namely,  more 
than  two  thirds,  went  insane  within  the  first  two  years  of  their 
imprisonment,  and  that  more  than  one  half  of  them  were  in  soli- 
tary confinement  before  the  appearance  of  the  mental  disorder,  so 
that  its  unfavorable  influence  cannot  be  doubted.  Among  Knecht's 
diagnoses  the  various  forms  of  paranoia  (Wahnsinn  and  Verriick- 
theit)  played  a  most  important  role.  The  paranoia  manifested 
itself,  as  a  rule,  in  the  persecutory  psychosis  of  the  criminal  so 
classically  delineated  by  Delbriick.  Prognosis  of  the  disorder  is 
unfavorable;  thus  of  sixty-nine  only  six  recovered.  Besides  epi- 
lepsy, melancholia  with  a  good  prognosis  was  very  frequent,  out 
of  thirty-six,  twenty  recovered.  Aside  from  this  Knecht  observed 
twelve  cases  of  circular  or  periodic  psychoses,  and  believed  that 


1 8  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

especially  among  partially  recovered  cases  of  circular  insanity, 
cases  of  moral  insanity,  hypochondriacal  paranoia  (Verriicktheit), 
etc.,  many  would  escape  notice  as  the  disease  picture  might  easily 
be  hidden  under  the  products  of  disciplinary  errors.  Mania  and 
paresis  were  represented  respectively  by  eleven  and  twelve  cases, 
thus  in  a  much  smaller  ratio  than  they  are  wont  to  occur  in 
freedom. 

In  the  same  year  appeared  Kirn's  brief  contributions  concern- 
ing prison  psychoses.  The  investigations  of  Delbriick,  Gutsch,  and 
Knecht,  concerned  themselves  chiefly  with  grave  offenders.  Kirn 
conducted  his  studies  among  the  insane  of  the  Freiburg  county 
jail,  which  served  for  the  detention  of  milder  offenders — these 
being  kept  in  solitary  confinement.  As  a  general  rule,  therefore, 
only  short  term  sentences  were  served  here,  by  far  the  majority 
not  over  one  year,  those  of  two  or  three  years  being  relatively 
rare.  The  number,  therefore,  of  previously  unconvicted  criminals 
by  passion  is  not  a  small  one,  namely  of  such  persons  who  in  the 
heat  of  excitement  committed  offences  against  the  person,  or  when 
sensually  excited,  crimes  of  a  sexual  nature.  It  was,  therefore, 
to  be  expected  that  Kirn's  results  would  differ  from  those  of  the 
former  authors.  Kirn  gives  a  review  of  forty  cases  observed  by 
him  at  Freiburg  between  October,  1879,  and  1880.  In  the  major- 
ity of  cases  he  holds  certain  individual  factors,  such  as  hereditary 
taint,  feeble-mindedness,  drunkenness,  etc.,  co-responsible  for  the 
occurrence  of  the  mental  disorder.  Only  in  six  of  the  forty  cases 
were  these  entirely  wanting.  The  exciting  factor  was  the  impris- 
onment itself,  with  its  deprivations  and  wants,  its  completely 
changed  mode  of  existence,  and  especially,  its  isolation  with  its 
grave  influence  on  the  emotions.  The  fact  of  the  greater  fre- 
quency of  mental  disorders  among  criminals  by  passion  than 
among  the  habitual  criminals  was  established  by  Kirn.  To  the 
moral  offenders  and  criminals  by  passion  which  Kirn  collectively 
considers  as  due  to  the  overflow  of  exaggerated  sensual  tendencies 
and  strong  emotional  aft'ects,  belongs  the  overwhelming  number 


FIRST   PERIOD  1 9 

of  twenty-three  of  his  forty  cases.  Crimes  which  only  gradually 
dulled  the  moral  sense — offenses  against  property,  such  as  theft, 
fraud,  embezzlement  and  concealment  of  stolen  property — were 
only  represented  by  seventeen  cases,  therefore  by  a  much  lesser 
number,  which,  according  to  Kirn,  would  have  been  still  smaller, 
were  it  not  for  the  fact  that  many  of  these  cases  were  predisposed 
to  mental  disorder  by  various  factors  previously  mentioned. 
Among  his  forms  of  insanity,  Kirn  observed  two  which  were  espe- 
cially frequent  in  their  occurrence,  namely  melancholia,  seventeen 
cases;  and  paranoia  (Verriicktheit)  thirteen  cases.  The  prepon- 
derance of  melancholia  Kirn  attributes  to  the  depressive  influences 
on  body  and  mind  which  manifest  themselves  as  the  results  of  the 
former  life  of  crime  and  imprisonment.  Kirn's  melancholia, 
which  manifested  itself  exclusively  in  the  affect  domain  without 
allegorizing  delusions  and  hallucinations,  occurred  only  once 
among  the  seventeen  cases.  The  melancholia  stupida,  with  its 
complete  psychic  constraint  and  outward  physical  and  mental 
retardation,  occurred  likewise  only  once,  whereas  the  distinct 
hypochondriacal  melancholia  furnished  five,  the  hallucinatory  mel- 
ancholia six,  and  lastly  the  agitated  melancholia  four  cases.  Kirn 
attributes  to  solitary  confinement  the  preponderance  of  the  above 
forms  over  the  otherwise  very  common  simple  melancholia. 

In  melancholia  with  predominating  auditory  hallucinations,  the 
hyperasthesia  of  the  hearing  centers  which  is  brought  about  by 
solitude  plays  an  especially  important  role. 

Next  to  melancholia,  paranoia  (Verriicktheit)  comes  with  thir- 
teen cases.  He  subdivides  these  into  two  distinct  groups.  The 
first  which  does  not  differ  in  the  least  from  ordinary  primary 
paranoia  (primare  Verriicktheit)  develops  gradually  on  the  basis 
of  the  ideational  life,  reaching  its  fastigium  slowly,  mostly  with 
nihilistic  delusions,  more  rarely  with  those  of  a  litigious  char- 
acter. To  this  group  belong  nine  cases.  In  contrast  to  this 
there  is  another  group  which  etiologically  can  be  attributed  only 
to  the  specific  influence  of  solitary  confinement.     To  this  group 


20  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

belong  all  those  cases  which  develop  rapidly  without  any  pro- 
dromal symptoms,  but  which  at  once  appear  in  their  completeness. 
It  is,  therefore,  an  acute  paranoia.  This  particular  form  of  prison 
psychosis  does  not,  according  to  Kirn,  occur  very  frequently.  He 
only  observed  four  cases  among  his  forty.  The  disturbance  is 
characterized  by  the  occurrence  of  numerous  and  intense  halluci- 
nations in  all  fields  of  the  sensorium  which  are  of  a  stable  char- 
acter, and  completely  transform  the  content  of  consciousness.  In 
a  euphoric  and  exalted  mood  the  prisoner  awaits  hourly  the  pardon 
which  was  proclaimed  him,  the  visit  of  some  high  personage,  and 
is  completely  taken  up  with  the  difficult  problem  which  confronts 
him.  Wholly  hallucinatory  experiences  in  which  most,  or  all  of 
the  spheres  of  the  sensorium  participate,  may  present  themselves 
to  him.  This  acute  paranoia  differs  definitely  from  the  chronic 
type,  especially  because  it  has  a  good  prognosis. 

Eight  years  later  Kirn  was  again  able  to  discuss  this  subject 
by  means  of  his  more  extensive  experience  and  greater  amount  of 
casuistic  material.  He  had  at  his  disposal  at  this  time  the  clinical 
material  of  the  Freiburg  county  jail,  which  came  under  his  obser- 
vation between  February,  1879,  and  December,  1886,  in  all  one 
hundred  and  twenty-nine  cases.  He  again  emphasized  the  extra- 
ordinarily deleterious  effects  of  prison  life  upon  the  psyche  of  the 
prisoner,  and  maintained  that  without  doubt  solitary  confinement 
had  a  graver  influence  than  did  mass-confinement.  At  the  same 
time,  however,  he  demonstrated  that  by  far  the  greater  majority 
of  his  patients  were  predisposed  to  mental  disorder;  only  in  15 
cases  were  such  predisposing  factors  absent  in  the  individual's 
life  prior  to  his  confinement,  when  the  mental  disorder  had  to  be 
attributed  exclusively  to  solitary  confinement.  From  Kirn's  in- 
vestigations it  further  became  apparent  that  the  view  expressed 
by  other  authors  to  the  effect  that  the  danger  of  mental  disorder 
grows  with  the  duration  of  the  isolation  was  totally  unfounded; 
mental  disorders  much  more  frequently  developed  in  the  first  half 
year,  diminished  about  the  fifth  month,  were  very  much  less  fre- 


FIRST   PERIOD  21 

quent  in  the  second  half  year  and  entirely  absent  after  the  first 
year.  The  likelihood  of  the  development  of  mental  disorder  be- 
comes, therefore,  less  as  time  progresses;  the  individual  becomes 
accustomed  to  the  abnormal  conditions. 

Kirn  divides  his  one  hundred  and  twenty-nine  cases  into  three 
groups  as  follows:  In  the  first  group  (19  cases)  he  places  those 
which  were  already  affected  on  admission  to  jail.  These  were 
mostly  grave,  chronic  disorders.  In  the  second  group  (95  cases) 
those  predisposed  to  mental  disorder.  These  were  wont  to  de- 
velop most  frequently  the  acute  psychoses,  melancholia  and  para- 
noia; and  the  third  group  (15  cases)  consisted  of  absolutely 
healthy  individuals  at  the  time  of  imprisonment,  who  also  devel- 
oped most  frequently  the  acute  disturbances,  and  had  a  favorable 
prognosis.  Thus,  according  to  Kirn,  the  psychoses  of  solitary 
confinement  are  characterized  by  a  great  preponderance  of  melan- 
cholia, and  by  the  frequency  of  acute  onsets.  Aside  from  this,  no 
other  distinctive  signs  of  its  origin  can  be  made  out.  Those  cases, 
however,  in  which  solitary  confinement  can  be  definitely  consid- 
ered as  the  etiologic  factor,  show  a  certain  specific  stamp.  Kirn, 
therefore,  reservedly  established  the  dictum,  namely  "the  more 
pronounced  the  predisposition  which  the  prisoner  brings  with  him 
to  the  prison  the  more  likely  it  is  for  the  psychosis  developing  sub- 
sequently to  assume  one  of  the  ordinary  forms  of  mental  disor- 
ders, conversely,  the  less  pronounced  the  psychopathic  predispo- 
sition, the  greater  are  the  probabilities  that  the  psychoses  develop- 
ing after  confinement  will  assume  a  more  specifically  characteristic 
form."  From  the  clinical  point  of  view.  Kirn  divides  his  one 
hundred  and  twenty-nine  cases  into  two  great  subdivisions,  namely, 
the  acute  and  chronic  psychoses.  These  he  subdivides  again  into 
numerous  subgroups  and  forms.  Among  the  chronic  psychoses 
chronic  paranoia  with  its  nineteen  cases  without  doubt  is  of  espe- 
cially frequent  occurrence.  These  chronic  delusional  states  he 
again  subdivided  into  three  groups.  To  the  first  group  belong 
those  cases  of  gradual,  slowly  developing  paranoia  not  dependent 

3 


22  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

upon  prison  life.  To  the  second  group  belong  the  majority  of 
cases.  These  paranoid  states  may  be  considered  as  a  further  de- 
velopment of  intellectual  enfeeblement,  as  a  transition  of  the 
psychic  degeneracy  into  a  chronic  mental  disorder.  Along  with 
hereditary  taint  Kirn  finds  in  these  cases  an  intellectual  weakness 
which  existed  from  childhood,  which  is  manifested  by  a  tendency 
to  an  inactive  tramp-life,  vagabondage  and  immoral  inclinations. 
Very  frequently  these  individuals  are  the  terror  of  their  neigh- 
borhood as  the  result  of  their  extreme  irritability.  They  are 
morally  color-blind,  and  therefore  lend  themselves  to  the  salutary 
influences  of  neither  home  nor  school  training  or  to  the  effects  of 
repeated  imprisonment.  Their  immoral  existence  and  long  prison 
sentence  are  still  more  injurious  to  them.  Often  mental  disturb- 
ances had  already  occurred  during  previous  incarceration,  but  were 
either  not  recognized  or  were  only  more  aggravated  by  disciplinary 
measures.  It  is,  therefore,  impossible  in  many  cases  to  fix  the 
exact  date  of  onset  of  the  disorder  inasmuch  as  the  transition 
from  congenital  degeneracy  into  a  psychosis  is  a  very  gradual  one. 
In  the  course  of  the  further  development,  hallucinations  of  all 
fields  of  the  sensorium  along  with  various  delusions  develop,  such 
as  were  minutely  described  by  Sommer.  Kirn  considers  this  form 
of  chronic  paranoia  as  identical  with  Sommer's  prison  paranoia. 
He  proposes  for  them  Delbriick's  old  name — the  paranoia  of  the 
criminal  in  contradistinction  to  his  acute  form  which  better  de- 
served the  name  of  prison  psychosis. 

The  third  subdivision  of  his  chronic  paranoia  differs  essen- 
tially from  the  preceding  one.  Here  it  concerns  individuals  who 
do  not  belong  among  the  moral  defectives,  who  have  not  left 
behind  them  a  criminal  career.  They  become  ill  without  any 
prolonged  premonitory  stage,  develop  insomnia  and  physical  in- 
disposition, and  are  rapidly  attacked  with  numerous  fallacious 
sensory  perceptions.  This  acute  paranoia  which  is  to  be  dis- 
cussed more  in  detail  later  does  not,  however,  terminate  in  re- 
covery.    On  the  contrary,  the  delusional  ideas  become  more  and 


FIRST   PERIOD  2$ 

more  fixed  and  further  elaborated  by  means  of  persisting  hallu- 
cinations. In  this  way  we  get  the  development  of  chronic  par- 
anoia, setting  in  acutely  with  numerous  hallucinations  and  delu- 
sions, mostly  of  a  persecutory  type. 

Opposed  to  these  chronic  psychoses  are  the  acute  ones. 
These  are  again  subdivided  into  two  groups,  according  as  to 
whether  the  basis  for  the  development  of  mental  disorder  had 
already  existed  prior  to  imprisonment,  or  whether  the  main 
etiologic  factor  is  to  be  sought  in  the  imprisonment  itself.  To 
the  first  group  belong  the  epileptic  and  alcoholic  psychoses.  In 
the  second  group  we  find  three  cases  of  acute  mania,  twenty-nine 
of  acute  hallucinatory  melancholia,  six  of  acute  simple  melan- 
cholia and,  lastly,  twelve  cases  of  acute  and  subacute  paranoia. 

Of  these,  the  hallucinatory  melancholia  and  the  acute  and 
subacute  paranoia  are  of  especial  significance.  The  hallucina- 
tory melancholia  had  already  been  classed  by  Kirn  in  his  former 
work  as  the  most  representative  and  characteristic  psychosis  of 
solitary  confinement.  It  develops  very  rarely  under  other  cir- 
cumstances and  is  only  sparingly  found  in  insane  asylums.  The 
patients,  among  whom  are  many  criminals  by  passion  and  first 
offenders,  as  a  rule  sufifer  severely  from  the  eft'ects  of  solitary 
confinement.  They  are  remorseful  for  the  deed  which  they  have 
committed,  become  retrospective  concerning  their  troubles,  ma- 
terial and  moral  injustices  and  the  misfortunes  of  their  famiily. 
There  develops  a  moderate  depressive  state,  at  times  associated 
with  lamenting  and  crying,  but  in  most  instances  not  reaching 
beyond  moderate  psychic  depression.  Simultaneously  with  this, 
insomnia,  loss  of  appetite,  digestive  disturbances,  pressure  and 
pain  sensations  in  the  head,  emaciation  and  more  or  less  pro- 
nounced anemia  set  in.  Following  this  preliminary  stage,  which 
is  often  of  very  short  duration  and,  therefore,  easily  overlooked, 
but  which  is  never  wanting,  the  patient  is  suddenly  surprised  at 
night  by  hallucinatory  experiences  which  bring  on  an  anxious 
excitement.     These  manifestations  become  constant   from   now 


24  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

on,  in  many  cases  occurring  only  at  night,  in  others  also  in  the 
daytime.  Attentive  patients  not  infrequently  hear  at  first  a  hum- 
ming and  buzzing  in  their  ears,  unpleasant  noises  and  inarticulate 
sounds  which  they  cannot  understand  until  finally  they  hear  well 
differentiated  sounds  and  distinct  words  and  sentences.  At  this 
stage  the  sensory  deliria  become  very  active,  the  voices  are  dis- 
tinctly heard  and  perceived  and  referred  to  definite  persons,  fre- 
quently friends  or  relatives,  or  to  the  prosecuting  attorney  and 
judge. 

The  hallucinations  are  very  plastic  and  can  be  described  as 
a  rule  in  the  minutest  detail.  Auditory  hallucinations  predom- 
inate ;  next  come  those  of  sight,  but  tactile  and  olfactory  falla- 
cious sensory  perceptions  also  occur.  The  content  of  the  voices 
is  always  of  a  depressive  character  and  shows  a  certain  similarity 
in  all  cases.  Curse  words  of  the  most  disgusting  character,  re- 
proaches, various  accusations,  such  as  having  been  lewd,  etc., 
frightful  threats,  such  as  that  they  will  be  robbed  of  the  daylight 
or  executed.  They  can  hear  shots  fired,  and  various  noises  in- 
dicative of  the  preparation  for  their  execution.  The  visual  hal- 
lucinations are  very  vivid;  the  patients  are  frightened  by  threat- 
ening forms  of  scornful  mien,  by  persons  armed  with  knives,  by 
evil  ghosts,  skeletons,  black  birds  and  the  like.  The  state  of 
anxiety  often  reaches  a  degree  when  suicide  is  attempted.  Dur- 
ing the  more  lucid  intervals  the  patients  are  as  a  rule  painfully 
oppressed  or  more  rarely  irritable  and  morose.  Sleep  is  restless 
and  disturbed,  appetite  bad,  frequently  they  refuse  to  take  nour- 
ishment, and  complain  of  a  characteristic  pressure  in  the  head. 
As  long  as  the  hallucinations  persist  the  patients  are  totally  dom- 
inated by  them.  They  fully  believe  in  their  reality  and  fre- 
quently draw  conclusions  from  their  content  which  have  the 
character  of  delusions.  This  heightened  stage  of  the  disor- 
der lasts  only  for  a  short  while  if  removal  from  isolation  takes 
place  in  time  and  the  patient  is  treated  in  a  hospital  ward.  At 
first   the  hallucinations    disappear   whereas   the   belief    in   their 


FIRST   PERIOD  2$ 

reality  still  persists  then  the  depression  becomes  less  severe,  the 
anxiety  states  rarer  and  milder  in  character.  With  the  return 
of  normal  sleep  the  patient's  appetite  improves,  he  assumes  a 
normal  affect-tone,  the  former  hallucinations  are  perceived  by 
him  at  their  true  value  and  he  is  again  well.  The  duration  of  the 
disorder  is  anywhere  from  two  weeks  to  six  months. 

As  another  characteristic  of  the  mental  disorder  of  solitary 
confinement.  Kirn  mentions  an  acute  hallucinatory  paranoia,  a 
disorder  which  is  closely  allied  to  the  acute  hallucinatory  melan- 
cholia previously  described.  Kirn  considers  certain  of  these 
cases  as  transitional  states  between  the  two  psychoses.  Notwith- 
standing their  close  relationship  and  their  equally  good  recovery, 
they  show  a  different  mode  of  development.  Whereas  in  the 
melancholia  he  always  found  a  prodromal  stage  of  depression, 
the  prodromes  of  paranoia  are  limited  to  headaches,  sleepless- 
ness, anemia  and  alimentary  disturbances,  in  certain  cases  a 
certain  amount  of  irritability  also  exists.  At  times  even  the 
above  symptoms  are  wanting  and  the  psychosis  sets  in  acutely 
with  numerous  hallucinatory  disturbances  without  having  evi- 
denced any  prodromal  signs  whatsoever.  The  hallucinations, 
with  a  predominance  of  those  of  hearing,  are  as  a  ru4e  frequent 
and  changeable.  In  certain  cases,  however,  they  may  be  of  a 
more  monotonous  and  quite  stationary  character.  They  are  all 
very  vivid,  have  a  marked  influence  on  the  patient's  affect-tone, 
which  may  fluctuate  according  to  the  content  of  the  hallucina- 
tions, between  wide  extremes,  and  lead  sooner  or  later  to  delu- 
sional formation.  The  content  of  the  delusions  and  hallucina- 
tions is  a  very  varied  one,  in  most  instances  the  patients  hear 
persecutory  voices,  accusations,  tauntings,  allusions,  which  color 
the  delusional  ideas.  Not  infrequently  there  also  develop  gran- 
diose ideas,  the  patient  considers  himself  descended  from  a  king, 
possessed  of  riches,  etc.  The  acute  paranoia  differs  from  the 
chronic  in  that  the  various  ideas  are  more  vague  in  character,  are 
not  so  well  defined  and  systematized  as  those  of  the  chronic  dis- 


26  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

order.  Just  as  this  disorder  is  less  clearly  defined  than  the 
acute  melancholia,  so  too  its  prognosis  is  more  uncertain  and 
vague  than  that  of  melancholia.  With  proper  treatment  most 
of  these  cases  after  many  remissions  and  exacerbations  recover 
in  a  shorter  or  longer  period.  At  first  the  hallucinations  sub- 
side, the  belief  in  the  reality  of  the  various  delusional  ideas  is 
given  up  only  later.  Thus  nine  of  the  twelve  cases  recovered; 
in  two  the  results  could  not  be  determined,  and  a  third  one  passed 
into  a  chronic  form  of  the  disorder.  The  prognosis  would  have 
been  still  less  favorable  if  Kirn  had  added  his  four  cases  of 
prison  paranoia  which  also  had  certainly  developed  from  this 
acute  paranoia.^ 

^  In  an  abstract  of  a  paper  on  the  prison  psychosis  Wilmanns  has  shown 
that  by  means  of  catamnestic  researches  of  Kirn's  cases,  it  is  possible  to 
solve  certain  diagnostic  questions  in  this  disorder.  These  investigations 
were  carried  out  by  Homberger.  We  quote  certain  clinical  data  from 
this  work  which  will  appear  later.  Of  Kirn's  one  hundred  and  twenty- 
nine  cases,  one  hundred  and  five  could  be  followed  to  the  end  and 
definite  diagnoses  established.  Twenty-four  cases  escaped  investigation. 
Among  these  again  are  eleven  cases  which  are  no  doubt  chronic  alco- 
holics, senile  dements,  and  paretics.  The  rearrangement  of  the  diagnoses, 
therefore,  took  place  in  the  one  hundred  and  five  catamnestically  recon- 
structed cases.  Thirty-three  were  recognized  as  cases  of  dementia  precox. 
Their  division  into  early  and  late  forms  calls  attention  at  the  same  time 
to  the  diagnostic  variations  and  to  the  fundamental  cause  of  these.  Of 
the  twenty-four  belonging  to  the  early  forms  of  the  disorder  Kirn's 
opinion  with  respect  to  the  prognosis  was  correct  in  nine.  He  erred, 
however,  in  the  remaining  fifteen,  in  which  as  acute  prison  psychoses. 
Kirn  predicted  a  favorable  prognosis.  The  late  forms  show  an  erroneous 
prognosis  in  two  cases.  The  great  majority  of  the  unrecognized  early 
forms,  were,  during  the  time  of  their  imprisonment  in  Freiburg,  in  the 
initial  stages  of  their  psychosis,  some  in  very  acute  phases  of  the  same. 
Those  judged  correctly  showed  even  to  Kirn  unmistakable  signs  of 
chronicity.  After  all,  it  is  quite  immaterial  whether  Kirn  spoke  of  a 
chronic  hallucinatory  melancholia  or  a  chronic  paranoia,  so  long  as  he 
meant  by  this  nomenclature  a  dementing  process.  On  the  whole  it  can 
be  said,  as  Homberger  shows  in  detail,  that  the  majority  of  cases  can 
now  be  correctly  sized  up  from  the  material  which  was  then  at  Kirn's 


FIRST  PERIOD  2/ 

These  views  of  Kirn  were  opposed  several  years  later  by 
Kiihn  in  an  excellent  work  on  the  insanities  among  reformatory 
inmates,  without,  however,  taking  into  consideration  that  his 
material  differed  considerably  from  that  which  served  as  a  basis 
for  Kirn's  conclusions.  Kiihn  deemed  it  an  error  to  establish 
special  forms  of  insanity  among  prisoners  because  all  the  men- 
tal disorders  which  may  be  observed  in  them  can  be  placed 
easily  within  the  category  of  some  of  the  mental  diseases  ordi- 
narily known  to  us.  Of  course  the  deliria  of  a  great  many  in- 
sane criminals,  especially  those  suffering  from  paranoia  (Ver- 
riicktheit),  have  certain  features  in  common.  Gutsch,  Delbriick, 
Bar  and  others  have  indeed  correctly  observed  this,  but  these 
cases  do  not  on  that  account  speak  for  a  special  mental  disorder, 
and  it  is  superfluous  to  give  them  a  special  name,  as  for  instance, 
paranoia  of  the  criminal  (Verbrecherwahnsinn).  The  clinical 
characteristics  which  were  reported  by  them  do  not  justify  the 
attributing  of  a  special  entity  to  these  psychoses.  Finally,  Kiihn 
especially  criticizes  Kirn's  views.     He  does  not  believe  that  the 

disposal.  The  clinical  histories  found  in  Kirn's  records  are  not  wanting 
in  characteristic  detail.  His  observations  are  in  part  exceptionally  accu- 
rate and  acute.  He  was  deficient,  however,  in  the  view-points  concern- 
ing the  catatonic  symptoms,  and  was  ignorant  of  the  importance  of 
emotional  dulness.  However,  it  is  just  because  he  has  to  be  recognized 
as  a  thorough  and  an  independent  observer  that  the  differences  in  diag- 
noses and  the  real  progress  in  this  respect  become  apparent.  Of  special 
importance  besides  is  the  great  percentage  of  defective  and  psychopathic 
individuals  (76  per  cent.)  among  Kirn's  prisoners  who  suffered  from 
dementia  precox.  Only  in  five  instances  Kirn  predicted  unfavorable 
prognoses,  which  the  further  course  of  the  disorder  did  not  bear  out. 
This  was  caused  in  part  by  delusions  which  appeared  as  degenerative,  in 
part  by  the  long  drawn  out  course  of  an  acute  prison  psychosis.  What 
Kirn  designates  as  the  acute  stuporous,  hypochondriacal,  hallucinatory 
melancholias,  are,  according  to  our  present  conceptions,  various  types 
belonging  within  the  realm  of  degenerative  prison  psychoses.  His  cases 
of  acute  paranoia  with  favorable  prognosis  belong  likewise  to  this  second 
great  group  of  degenerative  delusional  types,  which  in  all  comprise  forty- 
nine   cases.     Only   in    rare   instances   Kirn    erred   in   his   conceptions   as 


28  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

preponderance  of  hallucinatory  experiences  is  a  characteristic 
feature  of  psychoses  originating  in  solitary  confinement.  The 
same  thing  is  seen  also  in  non-criminal  individuals  when  acutely 
insane,  or  in  the  chronic  msane  when  for  any  reason  they  have 
to  be  isolated.  He  further  refutes  Kirn's  assertion  that  acute 
hallucinatory  paranoia  with  depressive  deliria,  "  the  hallucina- 
tory melancholia,"  is  of  such  rare  occurrence  in  freedom,  but  so 
frequently  found  among  the  criminal  insane  as  to  justify  calling 
it  a  psychosis  of  solitary  confinement.  According  to  Kiihn 
milder  forms  of  hallucinatory  paranoia  do  not  infrequently  occur 
among  people  at  liberty.  They  subside,  however,  very  rapidly 
so  that  they  do  not  come  under  the  observation  of  the  asylum 
physicians.  To  the  prison  physician  who,  perhaps  in  this  respect, 
has  had  no  experience  among  ordinary  individuals,  these  cases 
appear  as  something  extraordinary.  We  see  Kiihn  make  the 
same  argument  against  the  views  of  Kirn,  which  Sommer  in  his 
day  made  with  respect  to  Gutsch's  observations.  All  cases  of 
acute  mania  or  melancholia  which,  as  prison  physician,  he  ob- 

regards  these  highly  suggestible  reactionary  forms  which  depended  upon 
the  milieu,  and  which  had  their  roots  in  the  original  personality.  That 
the  differential  diagnosis  is  much  more  difficult  in  a  prison  than  in  an 
asylum  was  shown  by  the  subsequently  dementing  dementia  precox  cases 
whose  early  stages  and  acute  phases  were  manifested  in  the  prison  cell. 
The  manifestations  of  "  feeling  sick,"  the  delusional  content  derived  from 
the  surroundings,  the  involvement  of  the  individuality,  gave  the  disease 
pictures  that  strong  reactive  coloring  on  which  the  diagnosis  hung.  Six 
cases  which  Kirn  placed  among  those  of  favorable  prognosis  belong  to 
manic-depressive  insanity  where  the  delinquencies  were  the  result  of 
either  the  manic  or  depressive  phases  as  the  case  may  have  been.  Thirteen 
catatonics  were  also  recognized  among  his  cases.  The  life  histories  of 
the  one  hundred  and  five  cases,  aside  from  the  interesting  clinical  material 
which  they  furnish,  showed  a  complete  picture  of  the  criminality  of  each 
individual  case.  In  the  degenerates  it  was  possible  to  separate  the 
juvenile  offenders  from  the  later  criminals — the  habitual  from  the  re- 
claimed ones.  The  not  inconsiderable  number  of  the  latter  (17)  shows 
that  prison  psychoses,  though  modes  of  reaction  of  the  degenerative 
psyche,  are  not  a  sign  of  anti-social  degeneracy. 


FIRST   PERIOD  29 

served,  called  forth  the  question  in  his  mind  whether  he  was 
dealing  with  actual  new  psychoses  occurring  in  a  previously 
normal  individual,  or  whether  these  were  episodic  manifesta- 
tions in  originally  defective  individuals,  in  insane,  in  epileptic, 
or  paretic  prisoners.  He  observed  doubtful  manic  and  depress- 
ive intervals  in  the  course  of  similar  mental  disorders  only  rarely 
among  inmates  of  reformatory  institutions.  Kiihn's  diagnostic 
tables,  in  accordance  with  his  clinical  conceptions,  are  in  con- 
trast to  those  of  Kirn,  very  simple.  Half  of  his  cases  he  desig- 
nates as  paranoia  (Verriicktheit). 

Two  years  later  there  finally  appeared  the  last  more  exten- 
sive work  of  the  older  school  on  this  subject,  namely  Naecke's 
"  On  Crime  and  Insanity  among  Women."  Naecke  continued 
the  work  of  Kohler,  and  studied  the  mental  disorders  of  one 
hundred  female  patients  at  the  Hubertusburg  Insane  Asylum. 
Forty-seven  of  these  had  been  at  one  time  or  another  in  their 
lives  in  conflict  with  the  law,  and  fifty-three  were  transferred 
directly  from  various  prisons  into  the  asylum.  Naecke  asserts 
that  the  majority  of  these  cases  had  already  been  insane  prior 
to  their  imprisonment,  and  that  in  those  cases  which  had  not  been 
predisposed  to  mental  disturbances  the  prison  environment  played 
no  great  part  in  the  production  of  the  disorder.  Even  in  those 
predisposed  it  could  not  be  definitely  stated  that  imprisonment  in 
itself  was  the  exciting  factor  in  the  production  of  the  psychosis. 
Mental  disturbances  occurred  three  times  as  frequently  among 
long  term  prisoners  as  among  short  term  ones.  The  majority 
of  the  cases  became  insane  during  the  first  years  of  imprison- 
ment; body  and  mind  once  having  become  accustomed  to  prison 
life  the  danger  of  mental  disorder  was  practically  nil.  Of  the 
fifty-three  patients,  seven  were  epileptic  and  one  a  paretic.  The 
remaining  forty-five  belonged  among  the  ordinary  mental  dis- 
orders. In  most  instances  they  were  considered  as  paranoia, 
only  six  having  been  designated  as  mania.  In  contrast  to  Kirn's 
findings,  cases  of  melancholia  were  entirely  wanting.     Thirty- 


30  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

five  of  the  thirty-nine  cases  of  paranoia  were  classed  as  hallu- 
cinatory confusion,  a  phase  which  frequently  ushered  in  the 
disorder.  Naecke  agrees  with  Kiihn  that  the  acute  hallucinatory 
melancholia  is  only  a  stage  of  paranoia.  The  description  of  this 
psychosis  corresponds  with  Sommer's  prison  paranoia.  Naecke 
does  not  see  anything  characteristic  in  it  which  would  justify 
its  designation  as  a  prison  psychosis.  According  to  him  there  is 
no  prison  psychosis.  The  only  characteristic  features  of  the  dis- 
order found  in  prisoners  therefore  are,  first,  the  predominance  of 
prim'ary  dementia ;  second,  the  frequency  of  amentia  and  acute 
paranoia,  and  lastly,  the  relatively  frequent  termination  of  the 
psychosis  in  dementia. ' 

Reviewing  the  literature  thus  far  cited,  one  sees  that  the 
material  from  which  the  various  investigators  drew  their  con- 
clusions was  rather  one-sided  and  uniform.  Delbriick,  Gutsch 
and  Knecht  investigated  serious  ofi^enders  with  long  term  sen- 
tences, Kiihn  reformatory  inmates,  Kohler,  Sommer  and  Naecke 
especially  chronically  insane  inmates  of  asylums  for  the  criminal 
insane,  and  only  Kirn  had  the  opportunity  to  observe  patients 
who  were  sentenced  for  short  terms  of  imprisonment.  Little 
attention  was,  however,  given  by  the  alienists  to  prisoners  await- 
ing trial. 

Reich  about  1871  was  the  first  to  touch  upon  these  in  an  im- 
portant work  entitled  "  Concerning  Acute  Mental  Disturbances 
in  Imprisonment,"  in  which  he  described  nineteen  patients  who 
were  taken  ill  either  while  awaiting  trial  or  during  a  short  term 
of  imprisonment,  and  who  were  observed  at  Illenau.  Among 
these  persons  we  must  naturally  seek  wholly  different  etiologic 
factors  for  the  mental  disturbances  than  among  the  previously 
described  prisoners.  The  effect  on  body  and  constitution  of  a 
long  imprisonment  and  the  moral  influence  and  greater  punish- 
ment connected  with  it,  are  lacking  here.  The  severe  affect 
brought  about  by  the  emotional  shock  of  the  arrest,  the  prelim- 
inary hearings,  and  identification,  an  affect  which  could  be  set 


FIRST   PERIOD  3  I 

aside  much  easier  under  ordinary  circumstances  than  in  impris- 
onment, is  to  be  looked  upon  as  the  cause  of  the  acute  mental 
disturbances.  Consequently,  acute  mental  disturbances  devel- 
oped very  early  in  confinement,  in  four  cases  within  the  first  few 
hours,  in  six  within  the  first  days,  and  in  nine  within  the  first 
weeks  after  arrest.  Reich  divides  his  nineteen  observations  into 
three  groups :  The  first  two  groups  which  will  not  be  discussed 
in  detail  here,  each  contain  only  two  cases.  The  third  comprises 
the  remaining  fifteen,  and  is  the  most  important  one.  These 
cases  are  characterized  by  peculiar  disease  symptoms,  especially 
those  by  which,  according  to  Reich,  the  acute  mental  disturb- 
ances of  the  imprisoned  are  distinguished.  Reich  describes  this 
form  as  follows :  "  Already  in  the  first  hours  or  days  after  impris- 
onment, or  soon  after  a  severe  emotional  shock,  a  kind  of  psychic 
tension  sets  in.  The  prisoner  becomes  silent,  chary  of  words, 
lost  in  brooding.  He  observes  little  of  what  goes  on  about  him, 
remains  motionless  in  the  same  spot.  His  face  takes  on  an  as- 
tonished expression,  the  gaze  is  stary,  vacant,  indefinite,  not 
fixed  on  any  object.  H  the  patient  makes  any  movements,  they 
are  hesitating,  uncertain  like  those  of  a  drunken  person,  vertigi- 
nous and  aura-like  sensations  occur,  a  severe  anxiety  overpowers 
the  patient  and  with  the  entire  force  of  a  powerful  afifect,  crowds 
out  all  other  conceptions  and  sensations  and  dominates  the  en- 
tire personality.  Consciousness  becomes  more  and  more  clouded, 
soon  there  appear  illusions,  hallucinations  and  delusional  ideas, 
especially  the  conception  of  unknown  evil  powers,  of  spirits  and 
demons,  and  of  demoniac  persecution  and  possession.  Simul- 
taneously the  patients  complain  about  all  kinds  of  sensations.  In 
isolated  cases  one  may  observe  convulsive  twitchings  of  both 
the  voluntary  and  involuntary  muscles.  Finally  severe  motor  ex- 
citements set  in.  The  patient  becomes  noisy,  screams,  runs  aim- 
lessly about,  destroys  and  ruins  everything  that  comes  in  his 
way.  With  this  the  disease  has  reached  its  height  and  at  the 
same  time  a  stage  necessitating  his  transfer  to  a  hospital." 


32  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

Among  the  symptoms  mentioned  by  him  as  especially  charac- 
teristic of  this  disorder,  we  would  mention  the  clonic  muscular 
twitchings  observed  in  many  cases,  contractions  which  convulse 
the  limbs  like  electric  shocks,  in  one  case  increasing  to  an  actual 
subsultus  tendinum,  and  above  all  the  profound  disturbance  of 
consciousness  which  Reich  considers  decisive.  At  the  height 
of  the  disease  consciousness  is  entirely  abolished,  and  later  there 
is  complete  amnesia  for  all  events  during  this  time.  In  other 
cases,  the  psychic  activity  has  become  absorbed  into  an  hallucina- 
tory dream-life,  of  which  more  or  less  clear  memory  pictures 
remain,  and  which  may  be  interrupted  by  temporary  moments  of 
clear  consciousness.  The  patient  often  no  longer  recognizes  his 
environment  and  the  people  about  him.  If  the  disturbance 
abates  he  frequently  wakens  as  from  a  dream.  Relatives,  who 
in  several  cases  were  permitted  to  enter  unexpectedly  in  order 
to  take  by  surprise  a  possible  simulation,  called  forth  neither 
astonishment  nor  the  expected  surprise.  The  aura-like  mani- 
festations preceding  the  unconsciousness  involuntarily  remind 
one  of  similar  epileptic  conditions.  The  disease  has  a  favorable 
prognosis,  seven  cases  recovered  in  a  short  time.  Four  of  these 
could  be  discharged  as  cured  after  only  four  weeks.  Five  cases, 
however,  passed  into  secondary  demential  states.  The  exhaust- 
ive and  vivid  disease  pictures  admit  no  doubt  in  a  number  of 
these  cases  that  they  concern  essentially  different  processes. 
Reich  himself  supposes  that  this  acute  prison  psychosis,  because 
of  its  nature  and  clinical  picture,  may  be  included  in  that  large 
group  of  psychically  abnormal  processes  developing  from  affect 
and  affect-like  conditions  although  it  is  apparently  peculiar  be- 
cause of  the  foreign  ground  from  which  it  sprung.  In  passing, 
we  would  mention  that  Reich  combines  the  manifold  other  dis- 
turbances of  the  criminal  insane  which  do  not  find  their  exciting 
factor  in  the  imprisonment  itself  under  the  name  of  pseudo- 
prison  paranoia  (Pseudogefangenenwahnsinn).  Among  these  he 
includes  the  demented  and  weak-minded  alcoholics,  paretics  and 
epileptics. 


FIRST   PERIOD  33 

For  very  many  years  this  work  was  the  only  one  which 
dealt  in  detail  with  the  psychoses  of  prisoners  awaiting  trial. 
Not  until  1888  did  Moeli  in  his  well  known  monograph  on  crim- 
inals, call  attention  to  a  symptom-complex  which,  although  often 
described,  had  never  been  correctly  explained.  He  spoke  of 
patients  in  whom  an  apparent  forgetfulness  of  well-known  facts, 
such  as  their  age,  the  multiplication  table,  inability  to  recognize 
coins,  went  alongside  with  the  advancing  of  positive  untruths 
concerning  their  former  life.  At  the  same  time  it  was  noticed 
that  although  the  answer  was  false,  it  had  a  certain  relation  to 
the  question,  and  showed  that  the  circle  of  correct  conceptions 
had  been  touched.  For  instance,  a  dollar  was  called  a  quarter, 
a  postage  stamp,  paper.  This  failure  of  the  simplest  thought  and 
memory  activity  in  an  otherwise  well  ordered  demeanor  natu- 
rally aroused  the  suspicion  of  simulation,  but  Moeli  designates  it 
as  a  not  infrequent  disease  symptom,  especially  among  prisoners 
awaiting  trial. 

The  observations  of  Moeli  remained  unnoticed.  Neisser  and 
Dietz  in  1893  ^^^  1897,  again  described  such  patients  as  malin- 
gerers. The  knowledge  of  this  disease  picture  became  better 
known  by  Ganser's  publication.  He  also  had  repeatedly  noticed 
in  prisoners  awaiting  trial  that  they  were  unable  to  answer  ques- 
tions of  the  simplest  kind  put  to  them  although  they  showed  by 
the  nature  of  their  answers  that  they  had  pretty  clearly  grasped 
the  sense  of  the  questions,  and  that  their  answers  betrayed  rather 
a  disconcerted  ignorance,  and  a  surprising  loss  of  knowledge 
which  they  certainly  had  possessed  formerly,  or  of  which  they 
were  still  in  possession.  Ganser's  patients,  in  contrast  to  those 
of  Moeli,  showed  a  very  conspicuous  demeanor  from  which  it 
was  plainly  to  be  seen  that  they  were  suffering  from  vivid  visual 
and  auditory  hallucinations.  At  the  same  time  there  existed  a 
more  or  less  distinct  clouding  of  consciousness  with  the  con- 
comitant presence  of  hysterical  stigmata,  especially  total  anal- 
gesia.    After  a  few  days,  the  disease  was  cured,  'he  patient  sud- 


34  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

denly  awoke  as  from  a  dream  and  had  a  more  or  less  complete 
amnesia  for  the  occurrences  during  the  period  of  clouded  con- 
sciousness. 

This  unusual  disease  picture  has  since  then  become  the  sub- 
ject of  numerous  publications  under  the  name  of  the  Ganser  twi- 
light state  (Ganser  syndrome)  :  Jolly,  Moeli,  Neisser,  Raecke, 
Westphal,  Lucke,  Foerster  and  others  have  since  devoted  especial 
attention  to  it.  Hey  has  written  a  monograph  on  it.  Of  the 
various  works  we  will  mention  only  Raecke's  publication,  espe- 
cially as  it  forms  the  basis  of  a  later  work  by  the  same  author. 

Raecke  designates  this  picture  as  described  by  Moeli  and 
Ganser  as  an  hysteric  twilight  state  developing  in  psychopathic 
or  weak-minded  persons  in  confinement  as  the  result  of  emo- 
tional excitement.  The  continual  hearings,  the  confusing  cross- 
questions,  the  excitement  and  fear  of  punishment,  finally  the  ill- 
effects  of  solitary  confinement,  shock  and  weaken  the  slight 
mental  tensile  strength  of  the  prisoner  to  such  an  extent  that  on 
the  one  hand  a  condition  of  apathy,  of  inability  to  concentrate,  a 
feeling  of  incapacity  to  think,  and  of  being  wholly  at  sea  sets  in 
accompanied  by  vertigo,  headache  and  other  nervous  complaints ; 
while  on  the  other  hand,  the  physiological  despair,  the  obstinacy 
of  the  prisoner  now  increases  to  pathological  manic  attacks,  now 
changes  to  stubborn  negativism,  sitiophobia  and  mutism.  At  the 
same  time  the  more  or  less  conscious  wish  to  be  considered  sick, 
and  in  consequence  of  that,  to  be  freed  from  imprisonment,  may 
influence  deleteriously  and  in  a  peculiarly  modifying  way  the 
disease  picture.  The  simple  questions  put  to  the  patient  by  the 
physician  may  influence  him  as  so  many  suggestions.  Raecke 
calls  attention  by  means  of  simple  and  instructive  case  histories 
to  the  manifold  similarities  which  these  conditions  may  show  to 
catatonic  processes.  He  shows  that  also  in  these  hysterical  twi- 
light states,  quite  aside  from  mutism,  negativism  and  catalepsy, 
peculiar  mannerisms  were  noted,  an  affected,  childish  way  of 
speaking,  motor  stereotypies,  swaying  of  the  head,  running  in  a 


FIRST   PERIOD  35 

circle,  queer  actions,  abrupt  elaboration  of  wholly  senseless  word 
combinations,  etc.  In  a  yet  much  more  pronounced  measure 
these  catatonic  symptoms  may  be  found  in  the  disease  picture 
which  Raecke  designates  as  hysterical  stupor  in  prisoners,  and 
to  which  he  devoted  his  next  work.  The  severe  forms  of  this 
condition,  which  may  extend  over  weeks  and  months,  are  liable 
to  be  confused  with  progressive  processes,  especially  as  the  symp- 
toms which  have  been  considered  by  many  as  positively  unfa- 
vorable prognostically  may  be  found  here  in  very  deceptive  imita- 
tions, that  is,  the  affected,  silly  manner,  impulsive  actions,  tem- 
porary verbigerations,  word  salad,  grimacing,  stereotyped  atti- 
tudes, etc. 

Hysterical  stupor,  according  to  the  view  held  by  Raecke,  is 
closely  related  to  the  Ganser  twilight  syndrome,  stuporous  condi- 
tions may  introduce  the  latter,  and,  vice  versa,  Ganser  complexes 
may  creep  into  the  stupor,  Raecke's  stupor,  like  Ganser's  twi- 
light syndrome,  frequently  develops  in  criminals  either  imme- 
diately after  arrest,  or  as  the  result  of  physical  or  psychic  exer- 
tions. Sometimes  the  stupor  is  preceded  by  a  convulsive  seizure, 
in  other  cases  by  a  prodromal  stage  with  general  nervous  com- 
plaints. The  stupor  follows  immediately  upon  this  prodromal 
stage,  or  a  short  mania  with  clouded  consciousness  supervenes. 
In  contrast  to  the  catatonic  condition  the  stupor  as  well  as  the 
Ganser  twilight-state  is  characterized  by  a  high  grade  of  impres- 
sionability by  occurrences  in  the  environment  which  at  any  time 
may  cause  a  sudden  transition  from  apparently  deep  stupor  to 
normal  manner  and  behavior.  Headaches,  vertigo,  and  hyster- 
ical stigmata  are  common  to  both  the  stupor  and  the  Ganser 
twilight  syndrome.  Improvement  sometimes  takes  place  sud- 
denly, but  as  a  rule  is  gradual  and  fluctuating.  The  duration  of 
the  disorder  varies.  It  may  last  from  hours  to  months.  There 
is  generally  a  more  or  less  pronounced  amnesia  for  the  occur- 
rences during  the  stupor. 


SECOND  PERIOD 

Already  in  the  works  of  Sommer,  Naecke  and  especially 
Kiihn,  the  conviction  gradually  gained  ground  that  the  disorders 
described  by  Gutsch  and  Kirn  as  melancholia  were  in  a  large 
measure  only  phases  of  an  extremely  varying  disease  picture, 
which  was  called  by  them  at  one  time  prison  paranoia,  at  an- 
other, simply  paranoia.  These  views  prepared  the  way  for 
Kraepelin's  teachings  of  dementia  precox  which  as  everywhere 
else  worked  in  a  fructifying  manner  in  the  field  of  the  prison 
psychoses. 

Under  the  personal  influence  of  Kraepelin  there  appeared 
Riidin's  first  work  concerning  the  clinical  forms  of  prison  psy- 
choses. As  the  basis  for  his  dissertation  he  had  those  patients 
admitted  during  nine  years  (1891  to  1900)  to  the  Heidelberg 
clinic,  patients  who  were  either  taken  ill  in  the  prison  itself  or 
suffered  there  a  severe  exacerbation  of  a  disease  acquired  earlier. 
Among  his  cases  there  are  eighty-four  men  and  ten  women.  A 
review  of  his  diagnoses  will  show  us  that  the  author  could  not 
form  a  decisive  opinion  in  seventeen  cases ;  nine  cases  were  diag- 
nosed as  alcoholic  psychoses,  eight  as  epilepsy;  three  as  hysteria, 
three  as  paranoia  and  three  belonged  to  rarer  forms  of  disease. 
The  remaining  fifty  patients,  that  is  33  per  cent.,  were  diagnosed 
as  catatonia,  i.  e.,  as  demential  processes  which  in  fact  differed 
in  no  way  from  types  which  are  quite  different  in  the  beginning 
but  towards  the  end  of  their  course  grow  more  and  more  alike, 
and  all  of  them  finally  terminate  in  the  peculiar  catatonic  demen- 
tia. The  first  and  the  most  numerous  type  Riidin  calls  the 
vagabond  type  (Vagantentypus).  Of  these  there  were  thirty- 
one  cases  in  all.  These  he  again  subdivided  into  several  sub- 
groups which  will  not  be  entered  into  closely  here.  In.  all  of 
them  after  an  average  or  excellent  development  in  youth,  an  as 

36 


SECOND   PERIOD  3/ 

yet  unknown  causative  factor  arose,  changing  entirely  their  per- 
sonality and  make-up.  Later,  in  all,  were  seen  excited  states, 
those  well  known  pictures  of  catatonia.  All  ended  in  the  de- 
mentia so  characteristic  for  this  disease.  In  some  of  the  cases 
a  vagabond  life  preceded  the  actual  disease;  in  others  it  followed 
it,  and  in  fact  the  disorder  sometimes  expressed  itself  in  insid- 
ious changes,  at  other  times  in  acute  disturbances.  As  a  second 
type  Riidin  describes  the  group  of  habitual  criminals,  in  all 
eleven  cases.  This  includes  individuals  inclined  from  youth  to 
crime,  those  who  have  passed  through  numerous  punishments 
for  theft,  embezzlement,  rape,  assault,  etc.,  and  who  finally  when 
placed  in  solitary  confinement,  developed  catatonia. 

Before  this  disorder  developed  they  showed  no  traces  of 
mental  disorder.  There  were,  it  is  true,  many  cases  not  en- 
tirely normal  psychically,  in  no  way,  however,  persons  with 
hebephrenic  traits.  Riidin  does  not  consider  himself  justified, 
therefore,  in  dragging  in  the  former  life  of  these  patients  as  pro- 
dromal stages  of  catatonia.  He  asserts  that  one  must  leave  it 
to  the  future  to  show  whether  in  these  cases  criminal  life  and 
late  catatonia  belong  clinically  together,  or  whether  the  latter 
breaks  out  on  the  basis  of  the  crime  without  being  related  to 
it  in  any  way. 

Finally,  the  third  group,  eighteen  cases  in  all,  is  formed  of 
healthy  individuals,  who,  though  partly  endowed  with  unfavor- 
able qualities,  were  arrested  on  account  of  some  one  serious  crimi- 
nal deed  or  felony.  Five  cases  of  these  occasional  criminals 
showed  acute,  three  subacute,  onsets.  All  of  them  presented  the 
typical  picture  of  catatonia.  Whether  they  were  already  ill  at  the 
time  of  the  commission  of  the  act  cannot  be  said  with  absolute 
certainty.  Certainly  their  behavior  during  the  trial  and  investi- 
gation caused  no  suspicion  of  mental  disturbance.  These  investi- 
gations led  Riidin  to  the  conclusion  that  an  actual  prison  psychosis 
does  not  exist  as  a  cHnical  entity,  but  that  imprisonment  may 
modify  in  a  characteristic  manner  the  symptoms  of  all  mental  dis- 

4 


38  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

turbances  so  that  every  psychosis  occurring  in  prison  may  tem- 
porarily show  a  symptom-complex  such  as  had  already  been  long 
ago  described  in  an  excellent  manner  by  Gutsch,  Kim  and  others. 
This  symptom-complex,  a  peculiar  hallucinatory  episode, 
Riidin  found  in  twenty-eight  of  his  cases,  viz.,  in  fifteen  catatonics, 
three  epileptics,  one  hysteric,  one  litigant,  one  sexual  pervert,  one 
imbecile  and  in  six  clinically  undififerentiated  cases.  Solitary  con- 
finement or  a  long  series  of  former  punishments  in  connection 
with  a  rather  curtailed  freedom  in  mass-imprisonment  was  the 
cause  of  the  outbreak  of  the  prison  symptoms  which  immediately 
disappeared  upon  the  removal  of  the  exciting  factor.  The  origi- 
nal disorder  on  the  basis  of  which  they  had  developed  alone  re- 
mained. Riidin  thought  it  conspicuous  that  the  hallucinatory 
episodes  developed  not  only  in  diseases  in  the  course  of  which 
hallucinations  are  an  everyday  occurrence,  but  also  in  those  forms 
where  they  are  extremely  rare,  as  in  imbecility  and  in  the  psycho- 
pathies. But  even  in  these  cases  Riidin  is  not  inclined  to  see  a 
special  independent  prison  psychosis ;  an  acceptance  of  that  would, 
according  to  his  views,  have  to  fulfil  the  following  postulates: 
First,  the  symptom-complex  need  not  necessarily  develop  on  the 
basis  of  a  psychopathic  personality.  Second,  onset  and  course  of 
the  disorder  must  be  typical.  There  must  be  either  recovery  or 
termination  in  a  dementia  characteristic  of  the  disease,  and  differ- 
ing wholly  from  others,  especially  from  the  catatonic  end  results. 
Third,  the  observations  upon  a  patient  developing  this  symptom- 
complex  during  imprisonment  must  extend  over  his  entire  life, 
both  before  and  after  imprisonment.  This  supposition  Riidin  be- 
lieves he  has  fulfilled  in  a  number  of  cases  which  he  observed  sev- 
eral years  later  as  voluntary  physician  in  the  insane  division  of 
the  state  prison  at  Moabit,  and  which  he  designates  as  a  form  of 
acute  hallucinatory,  persecutory  delirium^  in  imprisonment  with- 
out further  development  of  the  delusional  system  and  without 
correction.  This  concerns  itself  with  three  abnormally  predis- 
'  Delirium  is  here  used  in  the  sense  of  the  French  "  delire." 


SECOND   PERIOD  39 

posed  habitual  criminals,  who  after  a  two  or  three  years'  impris- 
onment suddenly  developed,  without  any  premonitory  signs,  falla- 
cious sensory  perceptions  while  in  solitary  confinement.  The 
hallucinations  appeared  chiefly  in  the  auditory  sphere,  but  visual 
and  very  exceptionally,  tactile  hallucinations  also  occurred.  These 
hallucinations  were  vivid,  persecutory  in  character,  bearing 
throughout  the  stamp  of  reality,  and  were  referred  to  definite 
persons  in  the  environment,  chiefly  those  who  had  to  perform 
important  functions  in  the  carrying  out  of  the  punishment.  There 
quickly  appeared  on  the  basis  of  these  combined  and  elementary 
hallucinations  of  hopes,  expectations  and  fears  which  entirely 
dominated  the  prisoner,  and  the  elements  of  which  were  the  more 
powerful  because  of  the  changed  afifect-tone,  as  a  systematization, 
though  not  very  extended,  with  a  persecutory  trend.  The  expla- 
nation of  the  supposed  destructive  plots  and  attempts  at  annihi- 
lation cannot  be  ascribed  to  feeble-mindedness,  but  keep  well 
within  the  sphere  of  reason,  if  the  subjective  reality  of  the  hallu- 
cinatory and  illusional  experiences  are  kept  in  mind.  While  the 
patients  maintain  with  great  emotion  and  unshakable  conviction 
the  reality  of  the  persecution  which  they  have  perceived  with  their 
own  senses,  and  energetically  protest  against  any  presumption  of 
mental  disturbance,  numerous  simultaneously  appearing  symp- 
toms, such  as  headache,  insomnia,  hypersensitiveness  to  external 
and  internal  stimuli,  loss  of  appetite,  etc.,  awaken  a  marked 
physical  disease  feeling.  All  taken  together,  the  feeling  and  the 
clear  conviction  that  their  existence  is  threatened,  the  disturbing 
constitutional  symptoms  which  are  mostly  conceived  as  direct  or 
indirect  results  of  murderous  plans,  make  the  prisoner  irritable, 
suspicious  and  anxious.  Just  this  severe  irritable  afifect  is  the 
characteristic  feature  of  the  whole  course  of  the  disorder.  It  is 
true,  the  mood  often  changes  in  its  intensity,  especially  if  the  dis- 
ease lasts  somewhat  longer.  Under  the  immediate  influence  of 
new  onslaughts  of  disappointments,  rage  and  despair  often  break 
forth  in  a  powerful  manner,  but  the  homogeneity  of  the  affect 


40  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

remains  intact.  There  is  never  a  sudden  turn  of  mood  as  a  result 
of  joyous  feelings  or  inner  experiences;  joyous  news  concerning 
proof  against  the  planned  destruction  or  the  promise  of  influential 
help  against  the  persecutors,  influence,  if  at  all,  only  very  tem- 
porarily, the  anxious  and  embittered  soul  of  the  patient.  This 
vivid  affect,  the  active  interest  in  the  occurrences  in  their  environ- 
ment, the  formal  correctness  and  naturalness  in  word,  script,  and 
demeanor,  is  especially  emphasized  in  contrast  to  similar  symptom- 
complexes  of  dementia  precox.  It  is  of  especial  importance  that 
a  further  development  of  the  delusional  system  of  definite  perse- 
cutions founded  mainly  on  hallucinations  appears  with  the  dis- 
appearance of  the  acute  symptoms  or  often  even  earlier  than  this. 
Insight  into  the  morbidness  of  the  belief  that  they  are,  or  have 
been  persecuted,  exists  neither  at  the  time  of  the  acute  symptoms, 
nor  for  a  long  time  after  their  disappearance. 

According  to  Leppmann  this  will  develop  in  freedom.  The 
disease  duration  extends  over  some  months,  sometimes  a  year. 
The  memory  for  events  during  the  illness  through  which  they 
have  passed  was  generally  good.  Amnesic  gaps,  as  well  as 
other  hysterical  symptoms,  were  lacking.  Riidin  leaves  the  ques- 
tion unanswered  whether  this  peculiar  disease  picture  occurs  ex- 
clusively on  a  soil  of  crime,  and  under  the  influence  of  prison 
life,  or  whether  it  may  also  be  met  with  among  irreproachable 
persons  at  large.  Leppmann,  in  an  appendix  added  to  Riidin's 
work,  expresses  the  conviction  that  the  cases  described  concern  a 
psychosis  which  develops  in  a  normal  psyche  through  the  con- 
tinued influence  of  imprisonment  and  may  be  favorably  influenced 
through  changes  in  the  prison  conditions.  Leppmann,  however, 
cannot  see  in  it  a  special  prison  psychosis,  but  rather  believes  that 
he  has  seen  similar  symptom-complexes  develop  in  freedom  under 
similar  conditions. 

A  year  later,  there  appeared  a  work  by  Skliar,  the  basis  of 
which  was  sixty  case  histories  which  he  had  collected  from  vari- 
ous insane  institutions  in  Switzerland.      Skliar  differentiates  among 


SECOND   PERIOD  4 1 

these  five  alcoholic  deliria,  twenty-one  acute  prison  psychoses, 
twenty-one  demential  psychoses,  and  thirteen  cases  of  paranoia. 
The  development  of  the  acute  prison  psychoses  is  looked  upon  as 
very  characteristic.  After  a  short  prodromal  stage,  introduced 
by  irritability  and  depression  there  develop  quickly,  mostly  in  the 
first  days  of  the  imprisonment,  sometimes  even  in  the  first  hours, 
manifold,  anxious,  mocking  auditory  hallucinations,  fear-creating 
visual  hallucinations,  and  in  severe  cases,  even  those  of  smell, 
taste  and  general  sensation.  Delusional  ideas  of  being  killed, 
burned,  decapitated,  or  innocently  condemned,  also  develop.  The 
patients  become  senselessly  anxious,  restless  and  violent.  At  the 
same  time  there  exists  depression  and  disorientation,  while  often 
a  stupor  with  catatonic  symptoms,  negativism,  mutism,  constrained 
attitudes,  interchanging  with  furious  attacks  of  mania,  develops. 
The  disease  reaches  its  height  in  from  one  to  two  days,  and  is  very 
quickly  cured,  even  inside  of  hours  or  days,  upon  the  transfer  of 
the  patient  to  an  insane  asylum.  In  rare  instances  recovery  sets 
in  after  a  more  prolonged  period. 

The  description  which  Skliar  gives  us  of  the  acute  prison 
psychoses  reminds  one  strongly  of  Reich's  delineation.  The  au- 
thor has  also  so  far  as  the  extremely  meager  histories  permitted 
of  a  conclusion,  generally  judged  his  patients  correctly.  But  it  is 
an  incorrect  observation  of  Skliar  wherein  he  claims  to  rediscover 
the  same  symptoms  in  acute  prison  psychoses  which  he  found 
in  the  development  of  demential  processes  in  paranoiacs,  and 
without  further  discussion  designates  them  as  of  equal  importance. 
Hence  nobody  will  be  inclined  to  agree  with  the  solution  which 
Skliar  finally  gives  us  to  the  difficult  question,  namely,  "  in  soli- 
tary confinement  there  develops  mostly  an  acute  prison  psychosis 
which  is  cured  by  the  abolition  of  imprisonment,  but  which  passes 
into  a  dementing  psychosis  if  the  imprisonment,  especially  solitary 
confinement,  continues  for  a  more  or  less  prolonged  time  after 
the  disease  sets  in.  In  mass-imprisonment  an  acute  prison  psy- 
chosis may  likewise  develop,  but  generally  after  quite  a  long  time, 
and  here  we  may  be  dealing  with  a  true  paranoia." 


42  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

Longard  had  previously,  in  an  address  before  the  Prison  So- 
ciety of  Cologne,  called  attention  to  a  special  form  of  quite  acute 
mental  disturbance  which  he  had  observed  in  prisoners  awaiting 
trial.  He  makes  solitary  confinement  principally  responsible  for 
its  development,  because  he  did  not  meet  it  with  the  same  fre- 
quency among  prisoners  awaiting  trial  in  mass-confinement.  The 
form  of  this  solitary  confinement  psychosis  was  a  violent  hallu- 
cinatory confused  state  which  set  in  mostly  with  severe  manic 
excitement  accompanied  by  many  visual  and  auditory  hallucina- 
tions of  a  threatening  nature.  Those  attacked  were  in  the  ma- 
jority of  instances  healthy,  strong  individuals  who  had  formerly 
been  entirely  normal  and  did  not  look  back  upon  a  long  career 
of  crime.  He  never  noticed  these  psychoses  in  habitual  criminals 
upon  whom  imprisonment  no  longer  makes  the  slightest  impres- 
sion. The  disease  was  strongly  influenced  by  change  of  environ- 
ment, and  was  cured  in  a  short  time  after  the  patient  had  been 
taken  to  a  hospital  and  placed  in  a  room  with  other  patients  under 
proper  care.  This  acute  hallucinatory  confusion  Longard  desig- 
nates as  the  characteristic  solitary  confinement  psychosis  among 
prisoners  awaiting  trial.  It  is  much  rarer  among  the  condemned 
prisoners.  The  psychoses  of  the  latter  do  not  differ  from  those 
of  the  free  population,  only  the  numerical  relation  of  the  different 
disease  groups  differs  from  that  in  liberty.  Mania,  melancholia 
and  paresis  appear  much  less  frequently  than  paranoia  and  the 
various  forms  of  dementia. 

We  will  consider  only  hastily  the  work  of  Monkemoller  as  it 
devotes  itself  more  to  practical  questions,  and  only  superficially 
and  in  a  less  happy  manner  touches  upon  the  clinical  aspects. 
Hence  we  will  only  mention  that  he  too  does  not  recognize  a 
prison  psychosis  as  a  disease  stii  generis,  but  agrees  with  the 
opinion  advanced  in  Riidin's  first  work,  according  to  which  im- 
prisonment may  give  a  certain  common  coloring  to  the  clinical 
pictures  of  various  disease  processes. 

According  to  Monkemoller  this  concerns  essentially  halluci- 


SECOND  PERIOD  43 

natory  episodes  of  longer  or  shorter  duration  which  may  show 
at  one  time  the  characteristics  of  melanchoHa,  at  another  those  of 
paranoia,  and  above  all  those  of  acute  paranoia  (Verriicktheit). 
Whether  these  acute  psychoses  become  chronic  or  not,  depends, 
according  to  this  author,  essentially  upon  the  treatment,  that  is, 
upon  the  cessation  of  imprisonment.  The  mistaking  of  this  dis- 
turbance and  the  frequent  disciplinary  punishmient  only  too  readily 
forces  the  disease  into  a  chronic  course. 

It  is  likewise  unnecessary  to  go  into  the  thesis  of  Hoffmann 
concerning  prison  psychoses  and  psychoses  in  prison.  The  au- 
thor attempts  in  the  main  to  prove  by  a  number  of  illustrations 
the  frequency  of  simulation  in  prison.  We  hear  nothing  new  or 
noteworthy  concerning  clinical  questions. 

The  thesis  of  Pollitz  concerning  solitary  confinement  and  in- 
sanity deserves  a  brief  mention.  Pollitz  is  head  physician  in  the 
insane  department  of  the  prison  at  Miinster  in  W.  He  is  decid- 
edly opposed  to  the  claim  that  solitary  confinement  more  frequently 
calls  forth  mental  disturbances.  In  only  eight  or  nine  of  the 
sixty-four  mentally  disturbed  apportioned  to  his  department  and 
coming  from  solitary  confinement  could  Pollitz  connect  appear- 
ance, course  and  form  of  the  disorder  in  any  justifiable  manner' 
with  their  imprisonment,  or  ascribe  to  the  solitary  confinement  a 
definite  share  in  the  outbreak  of  the  disease. 


THIRD  PERIOD 

We  must  review  carefully  the  comprehensive  and  almost  ex- 
clusively clinical  work  of  Siefert,  physician  in  charge  of  the  obser- 
vation station  for  the  insane  at  Halle.  Siefert  bases  his  results 
on  the  observation  of  eighty-seven  patients.  These  he  divides 
into  two  sharply  differentiated  groups,  the  degenerative  prison 
psychoses  and  the  true  psychoses;  to  the  former  belong  fifty-four 
cases,  to  the  latter  thirty-three. 

The  degenerative  mental  disorders  are  products  of  predispo- 
sition and  environmental  influence.  They  bear  a  close  relation  to 
the  deleterious  effects  of  imprisonment,  are  influenced  to  the 
greatest  degree  by  the  change  of  milieu  and  occur  predominately 
in  the  habitual  criminal  in  his  third  decade  of  life.  The  morbid 
predisposition  upon  which,  under  the  influence  of  imprisonment, 
the  prison  psychoses  develop,  is  well  characterized  by :  "  change- 
ability, irritability,  autochthonous  fluctuations  of  mood,  phantastic 
day-dreaming,  exaggerated  subjectivity  to  the  environment  with 
inability  to  assume  a  stand-point  of  correct  critical  judgment  con- 
cerning unpleasant  occurrences  in  their  surroundings,  and  a  marked 
suggestibility.  The  foregoing  are  common  manifestations  in  the 
psychic  sphere  of  these  individuals.  The  tendency  to  headache, 
to  migrainous  attacks,  restlessness,  a  feeling  of  anxiety  often 
associated  with  disturbances  of  cardiac  action,  hypochondriacal 
complaints,  a  tendency  to  become  easily  tired  on  mental  and  bodily 
exertion,  intolerance  and  pathological  reactions  toward  alcohol, 
etc.,  complete  the  picture  on  the  neurological  side.  An  element 
of  intellectual  weakness  is  often  to  be  found,  but  only  seldom 
intensively  represented,  and  even  then  its  significance  for  the  indi- 
vidual and  his  social  development  can  only  take  a  secondary  place 
to  that  of  the  affective  disturbance."  The  degenerates  growing 
up  in  an  unfavorable  milieu  break  down  even  in  childhood,  while 

44 


THIRD   PERIOD  45 

those  developing  under  more  favorable  circumstances  manifest 
these  traits  at  a  later  age.  The  injurious  effects  of  an  unstable, 
dissipated  existence,  a  life  full  of  privation,  serve  to  exaggerate 
the  pathological  elements,  "  until  after  a  number  of  years  (almost 
all  patients  were  in  the  third  decade  of  life)  often  apparently  sud- 
denly or  indicated  by  premonitory  signs,  collapse  occurs  in  prison. 
Psychotic  symptom-complexes  now  flare  up  and  illuminate  grimly 
the  individual's  past:  thus  we  see  deliria,  convulsive  seizures,  de- 
lirious confusional  states,  psychotic  intensifications  of  the  under- 
lying character,  wild  phantasies  of  unlimited  variation  appear  and 
disappear  in  a  characteristically  remitting  course.  While  they  are 
still  recent  and  dependent  upon  the  prison  environment,  medical 
interference  may  be  of  practical  value."  Medical  interference  is 
of  no  value  if  the  anti-social  tendencies  have  become  fixed  to  an 
excessive  degree,  if  the  specific  deleteriousness  of  a  prolonged  im- 
prisonment has  clouded,  distorted  and  obfuscated  the  individual's 
entire  mode  of  thinking;  or  if  the  phantastic  and  paranoid  con- 
stituents have  produced  psychotic  elements  of  which  the  patient 
can  no  longer  rid  himself.  This  is  likewise  true  if  the  enfeeble- 
ment  of  judgment,  the  irritable  subjectivity  and  paranoid  predis- 
position have  produced  incorrigible  delusional  pictures  and  the 
plastic  hallucinations  (which  so  easily  occur  under  the  influence 
of  solitary  confinement  in  these  patients  already  so  prone  to  hallu- 
cinatory delerioid  states)  have  become  fused  with  other  patho- 
logical elements.  There  then  develop  disease  pictures  of  a  com- 
plicated aspect,  imitations  of  true  psychotic  processes  which  fre- 
quently can  only  be  worked  out  with  difficulty,  and  which  analysis 
finally  shows  to  be  of  the  prison  psychotic  degenerative  type. 
This  becomes  especially  clear  if  the  degenerative  process,  its  rela- 
tion to  simple  degenerative  conditions,  the  noteworthy  fluctuating 
manifestations  which  are  so  dependent  upon  environmental  con- 
ditions, the  frequent  extraordinary  phantasy  which  is  something 
altogether  different  from  a  true  grandiose  delirium,  the  remark- 
ably  restricted  persecutory  delusional    formation,   the  artificial, 


46  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

often  conscious,  admixture  of  acquired  symptoms  picked  up  here 
and  there,  are  taken  into  consideration  and  properly  evaluated. 

Siefert  divides  his  fifty-four  cases  of  degenerative  prison  psy- 
choses into  the  following  not  sharply  delimitable  groups : 

I.  Hysteriform  degenerative  states:  Evident  cases  of  grave 
hysteria  with  convulsions,  physical  stigmata,  endogenous  states  of 
ill  temper,  confusional  and  Ganser  twilight  states,  etc. 

II.  Simple  degenerative  forms:  These  differ  from  the  first 
group  in  that  the  hysterical  stigmata,  convulsions,  etc.,  were  dis- 
coverable neither  in  the  anamnesis  nor  during  the  time  under 
observation.  In  some  of  these  cases,  it  was  the  degenerative  anti- 
social character-anomaly  of  the  most  severe  and  no  longer  cor- 
rigible type  which  brought  about  medical  interference;  in  the 
majority,  however,  various  psychotic  processes  in  the  form  of 
motor  excitement,  fearful  delirious  states,  mutism,  etc.,  developed. 

III.  Phantastic  degenerative  forms:  Profoundly  degenerated 
personalities  with  markedly  increased  imaginative  faculties,  marked 
auto-suggestibility,  inclination  toward  swindling  and  lying,  hyster- 
ical stigmata  and  endogenously  produced  fluctuations  of  mood. 
On  this  soil  there  develop  states  of  pseudologia  phantastica,  sys- 
tematized delusions  of  all  sorts  and  delirious  psychoses. 

IV.  Paranoid  degenerative  forms:  First,  the  litigious  form. 
The  litigious  element  gives  to  the  groundwork  of  the  prison  psy- 
chosis its  unique  coloring.  Some  cases  have  been  known  as  liti- 
gious paranoia  (Querulantenwahn).  The  litigious  paranoia  is 
not  really  a  disease  type  per  se,  but  only  an  artificial  creation  de- 
pending upon  the  make-up  and  external  influence,  a  psychosis 
which,  in  one  of  its  multiform  types,  develops  in  free  life  only 
very  seldom,  but  in  prison  with  greater  frequency. 

Further,  there  belong  here  the  hallucinatory  paranoid  forms : 
Hallucinations  and  delusions  of  persecution  supported  by  a  hypo- 
chondriacal element  produce  disease  pictures  which  show  an  ex- 
traordinary similarity  to  the  true  paranoid  formations  and  in  no 
wise  impress  one  as  prison  psychoses  of  degenerative  origin. 


THIRD    PERIOD  4/ 

V.  Prison  psychotic  states  with  simulated  symptoms:  These 
to  Siefert  point  to  a  type,  the  artificial  prison  psychotic  symptoms 
of  which  compel  the  assumption  of  conscious  deception. 

VI.  Dementia-like  states:  Individuals  in  whom  the  criminal 
career  began  early  in  life  and  whose  past  shows  no  record  of  pre- 
vious attacks,  but  who  after  an  unusually  prolonged  imprisonment 
(up  to  15  years)  quite  gradually  and  slowly  develop  a  peculiar 
behavior  which  leads  to  frequent  infractions  of  institutional  dis- 
cipline. They  refuse  to  attend  divine  worship,  to  perform  the 
required  work,  and  insist  persistently  on  their  discharge.  When 
finally  transferred  to  the  department  for  the  insane,  they  showed 
no  definite  hebephrenic  demential  manifestations,  but  evidenced, 
in  spite  of  a  comparatively  youthful  age  (one  was  only  35  years 
old),  a  more  or  less  marked  appearance  of  dementia  and  an  insane 
behavior.  Only  one  of  these  patients  in  whose  case  a  complex, 
prolix,  and  in  part  unintelligible  letter  is  quoted,  is  described  in  a 
few  words  as  being  generally  well  composed  and  orderly,  but 
capricious  and  stereotyped  in  behavior,  hardly  paying  any  atten- 
tion to  his  surroundings,  but  occupying  himself  exclusively  with 
the  most  profound  scientific  and  religious  problems.  Siefert  is 
inclined  to  the  opinion  that  here  we  have  to  deal  with  an  artificial 
product  of  imprisonment  which  develops  in  a  slightly  feeble- 
minded degenerate  possessing  a  tendency  to  phantastic  and  senti- 
mental phraseology. 

These  are  the  prison  psychoses.  Siefert  was  not  able  to  agree 
with  the  opinion  of  those  who  fundamentally  identify  these  psy- 
choses with  those  occurring  in  free  life,  and  who,  at  the  most, 
admit  that  imprisonment  lends  to  them  certain  peculiarities  not  in 
themselves  essentially  characteristic.  To  him,  the  prison  psy- 
choses are  a  reaction  of  a  pathologically  organized  brain  to  definite 
pathologic  conditions  of  life,  nothing  more  than  irradiations,  dis- 
tortions, and  new  formations,  resulting  from  the  same  causal 
factor  which  produced  the  crime. 

In  sharp  contrast  to  the  above  described  forms  (quite  as  much 


48  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

as  the  contrast  of  paresis  to  neurasthenia)  stand  the  true  psy- 
choses. In  the  true  psychoses  with  a  progressive  tendency  depend- 
ent upon  organic  causes,  "  the  inner  relation  between  the  original 
make-up,  the  crime  and  mental  disorder,  is  observed  but  vaguely ; 
here  the  uniform  monotony  which  is  concealed  only  of  necessity 
by  an  artificially  erected  symptomatologic  polymorphism  is  lacking. 
Here  the  significance  of  the  milieu  as  a  provocative  and  curative 
factor  in  the  psychotic  state  disappears."  The  true  psychoses 
originate  in  and  grow  out  of  inner  causes;  they  take  possession  of 
the  personality,  change  and  destroy  it,  according  to  organically 
determined  laws  and  put  in  its  stead  a  something,  wholly  new,  a 
psychotic  personality  borrowing  only  insignificant  characteristics 
from  the  particular  environment.  Criminal  life  and  mental  dis- 
turbance are  no  longer  branches  of  the  same  stem,  but  either  the 
individual  develops  the  psychosis  and  as  a  result  of  the  change  of 
personality  thus  occasioned  falls  into  criminal  habits,  or  we  are 
dealing  with  an  habitual  criminal  in  whom  the  psychosis  develops 
without  definite  relation  to  the  criminal  make-up  just  the  same  as 
in  a  law-abiding,  non-criminal  individual  in  freedom.  Siefert 
admits  as  a  third  possibility  that  the  prison  psychotic  symptom- 
complex  in  its  common  form  may  develop  upon  an  organic  psy- 
chotic basis  but  he  himself,  however,  thinks  that  this  is  only  rarely 
to  be  observed. 

Among  the  true  psychoses,  first  of  all,  the  senile  conditions  are 
wanting,  in  spite  of  the  fact  that  deteriorated  seniles  are  prone  to 
be  interned  in  great  numbers  in  penal  institutions,  on  account  of 
sexual  offences.  Likewise,  the  alcoholic  psychoses  are  wanting, 
nor  do  alcoholic  deteriorations  appear  as  a  foundation  for  prison 
psychotic  disturbances  (aside  from  delirium  tremens  which  very 
frequently  develops  in  connection  with  solitary  confinement). 

Thus  the  true  psychoses  are  divided  into : 

I.  Paretic  conditions,  which  appear  less  frequently  than  in  free 
life. 

II.  Epileptic  forms:  the  epileptics  of  the  prison  are  not  very 
different  from  those  of  free  life. 


THIRD    PERIOD  49 

III.  Progressive  feeble-minded  forms:  congenital  feeble-minded 
conditions  which  after  years  get  worse  and  express  themselves 
clinically  by  more  or  less  complete  transformations  of  the  per- 
sonality with  the  appearance  of  grave  psychotic  irritability  and 
invectiveness.  Definite  causal  relations  between  prison  and  pro- 
gression are  not  to  be  confirmed  (KraepeVm's Pfropf hebephrenia) . 

IV.  Hebephrenia,  catatonia,  and  other  chronic  psychoses:  In 
sixteen  cases,  Siefert  believes  the  entire  criminal  career  must  be 
regarded  as  a  result  of  an  already  existing  mental  disorder.  As 
proof  of  this  view  he  can,  however,  in  many  instances  merely  cite 
the  fact  that  the  criminal  career  first  began  after  the  eighteenth 
year,  while  the  originally  habitual  offender  would  be  expected  to 
become  criminal  earlier. 

In  the  remaining  six  cases  in  whom  criminality  began  in  early 
youth,  he  leaves  it  an  open  question  whether  the  psychosis  itself 
reaches  back  to  childhood,  or  whether  we  have  to  deal  perhaps 
with  a  degenerative  criminal  who  like  any  other  person  develops 
a  chronic  psychosis. 

In  the  dififerential  diagnosis  as  opposed  to  the  prison  psychoses, 
Siefert  selects  the  following  important  symptoms  from  those  com- 
mon to  other  psychoses.  The  association  of  persecutory  and 
grandiose  ideas,  an  absurd  interpretation  of  hypochondriacal  sen- 
sations, a  general  projection  of  the  delusions  upon  the  entire  en- 
vironment (in  the  prison  psychoses  these  are  never  projected 
upon  fellow  prisoners),  self-accusations,  physical  explanatory 
deliria.  Intense  emotional  states  with  persistent  insomnia,  danger 
of  suicide  and  self-mutilation  as  a  result  of  hypochondriacal  sen- 
sations, characteristic  neologisms,  etc.  On  the  other  hand,  accord- 
ing to  the  opinion  of  Siefert  the  narrowness  of  the  paranoid  field, 
its  limitation  to  immediate  surroundings,  is  in  favor  of  the  prison 
psychoses.  He  attributes  great  diagnostic  value  to  the  influence 
of  the  change  of  milieu  on  the  expression  of  the  disease  for 
"  when  a  disease  whose  symptoms  and  development  must  be  con- 
sidered absolutely  as  chronically  progressive  suddenly  becomes 


50  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

cured  when  the  patient  is  placed  under  different  surroundings,  it 
must  follow  conclusively,  and  of  natural  necessity,  that  it  is  not 
an  organic  disease  process  which  has  produced  the  psychotic  con- 
dition, but  the  milieu;  in  other  words,  the  psychosis  is  a  prison 
psychosis." 

The  consecutive  series  of  Siefert  includes  eighty-three  cases, 
fifty  of  which  were  prison  psychotic  states,  while  thirty-three  were 
psychoses  in  the  narrower  sense,  or  respectively  sixty  to  forty 
per  cent.,  in  which  forty  per  cent,  the  epileptic  and  profoundly 
feeble-minded  are  not  excluded  (without  these  the  relation  would 
have  been  sixty-one  to  thirty-one  per  cent.). 

Bonhoffer  finally  reached  opinions  similar  to  those  of  Siefert 
in  a  work  which  appeared  in  1907,  after  the  examination  of  the 
material  of  the  Breslau  Psychopathic  Institute  for  insane  crimi- 
nals. If  we  glance  at  the  table  of  Bonhoffer's  diagnoses,  we  see 
an  arrangement  similar  to  that  given  in  Siefert's  table.  The  rela- 
tive percentages,  however,  show  very  important  differences :  Bon- 
hoffer observed  among  his  cases  41  per  cent,  of  simple  dementing 
processes  as  opposed  to  Siefert's  31  per  cent.,  while  degenerative 
prison  psychoss  (33  per  cent.)  are  almost  by  one  half  rarer  than 
Siefert  found  them,  and  still  lower  than  Siefert's  60  per  cent.,  if 
we  include  imbeciles  and  cretins.  As  we  might  expect,  Bonhoffer's 
material  did  not  differ  essentially  from  that  of  Siefert's;  these  dif- 
ferences must  depend  on  the  divergent  clinical  and  diagnostic 
views  held  by  the  two  authors.  Evidently  Siefert  includes  under 
the  prison  psychosis  certain  cases  which  Bonhoffer  considers  as 
dementia  precox  and  epilepsy. 

Bonhoffer's  material,  apart  from  this,  again  confirms  the  con- 
clusions previously  reached  concerning  the  frequency  of  paresis, 
manic-depressive  insanity  and  simple  simulation.  The  cases  con- 
sidered as  dementia  precox  show,  in  his  opinion,  nothing  charac- 
teristic. On  the  other  hand  a  large  number  of  degenerative 
psychoses  give  a  unique  character  to  the  prison  material.  Bon- 
hoffer endeavors  to  segregate  from  the  manifold  pictures  several 


THIRD    PERIOD  5  I 

groups  and  begins  with  a  description  of  three  well-defined  symp- 
tom-complexes. 

The  first  group  Bonhoffer  designates  as  a  simple  paranoid  dis- 
order, if  one  wishes,  an  acute  paranoia,  on  the  basis  of  a  charac- 
teristic degeneracy,  the  erethistic  debility  which  is  well  defined  by 
a  combination  of  superficial  endowment,  feeble  comprehension,  a 
tendency  toward  change  of  occupation  and  early  criminality.  The 
psychosis  stands  in  direct  contrast  to  the  original  personality. 
During  imprisonment  there  develops  along  with  retention  of  men- 
tal acuity  and  allopsychic  orientation,  an  acute  paranoid  symptom- 
complex.  Amidst  an  acute  anxiety  state  there  develop  ideas  of 
reference,  ideas  of  influence,  isolated  hallucinations,  an  obsessive 
tendency  toward  a  depressive  recapitulation  of  the  individual's 
past,  nervosity  and  irritable  depression.  Of  interest  was  also  the 
psychotic  evaluation  of  dream  experiences  which  were  manifested 
by  ideas  of  having  been  nightly  tortured,  beaten  and  choked.  The 
duration  of  the  disorder,  which  may  show  a  remittent  course, 
varies  from  several  months  to  two  years.  The  delusional  forma- 
tion progresses  only  for  a  short  time  and  in  no  instance  leads  to 
a  retrospective  change  of  the  content  of  consciousness.  More  fre- 
quently the  process  subsides  quickly  without  leaving  an  alteration 
in  the  personality  upon  the  termination  of  the  imprisonment  and 
the  transfer  of  the  patient  to  another  environment.  Insight  is  not 
always  complete,  the  ideas  of  reference  and  the  ideas  of  prejudice 
directed  against  the  institution  personnel  may  remain  uncorrected. 

These  psychoses  can  in  no  wise  be  included  among  the  known 
forms  of  dementia  precox,  manic-depressive  insanity  or  epilepsy. 
The  course,  however,  reminds  one  of  hysterical  states  inasmuch 
as  the  intensity  and  the  disappearance  of  the  manifestations  show 
a  definite  dependence  upon  environmental  circumstances.  The 
confabulations  of  being  beaten  and  choked  which  have  their  source 
in  the  anxious  dreams,  also  remind  one  of  hystericals.  On  the 
other  hand,  the  uniformity  of  the  anxious  delirium  of  reference, 
the  isolated  phonemes,  the  fully  adequate  paranoid  aflfect,  the  re- 


52  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

tained  consciousness,  the  completeness  of  the  delirium  of  explana- 
tion are  entirely  lacking  in  the  hysterical  character.  We  have  to 
deal  with  psychoses  arising  on  a  basis  of  simple  degeneracy  which, 
just  as  is  the  case  in  endogenous  hysterical  or  epileptic  soil,  furnish 
a  predisposition  to  definitely  colored  episodic  psychic  disorders. 

Whereas  the  "  acute  paranoia  "  stands  in  direct  opposition  to 
the  original  personality,  the  second  group  comprises  psychoses 
which  are  to  be  considered  solely  as  an  exaggeration  of  an  al- 
ready existing  paranoid  disposition.  The  paradigm  of  this  mental 
disturbance  is  the  litigious  paranoia  (Querulantenwahn).  In  in- 
convincable,  stubborn,  fanatic  individuals,  there  develop  under 
favorable  circumstances  hyperquantivalent  ideas  in  the  sense  of 
Wernicke,  which  as  a  result  of  their  strong  affective  value,  lead 
to  frank  psychotic  symptoms,  to  positive  and  negative  falsifi- 
cations of  memory,  to  pathologic  auto-references  and  explanatory 
delusions  in  accord  with  the  content  of  the  dominating  idea. 
These  conditions  which  correspond  with  the  litigious  paranoia 
(Querulantenwhan)  rapidly  disappear  along  with  a  marked  gain 
in  bodily  weight  upon  removal  to  a  hospital  for  the  insane. 
They  are  therefore  curable.  Bonhoffer  believes  that  these  cases 
in  which  the  question  is  solely  one  of  paranoid  episodes  in  ab- 
normally predisposed  individuals,  represent  above  all  the  more 
frequent  type  of  course  of  the  litigious  paranoia.  To  speak  in 
such  cases  of  pseudo-querulants,  is  entirely  inappropriate.  We 
are  dealing  here  with  genuine  delusional  formations  developing 
on  a  basis  of  hyperquantivalent  ideas  and  deliria  of  reference 
with  genuine  falsifications  of  memory  as  far  as  the  dominating 
trend  of  thought  is  concerned.  These  cases,  according  to  Bon- 
hoffer's  opinion,  are  closely  related  to  the  entire  psychotic  patho- 
logical mechanism  of  the  true  paranoia  of  Kraepelin  in  the  nar- 
rowest sense.  They  are  to  be  considered  solely  as  reactions  of 
a  temperament  predisposed  to  the  development  of  hyperquantiv- 
alent ideas,  liberated  by  external  causes. 

In  the  third  group  Bonhoffer  describes  a  series  of  interesting 


THIRD   PERIOD  53 

cases  in  which  "  the  lability  of  the  ego  "  is  a  most  striking  mani- 
festation. The  individual  cases  differ  very  markedly  one  from 
the  other.  Two  of  these  became  ill  subacutely  in  prison  with 
an  original  delusional  system  composed  of  a  delirium  of  refer- 
ence and  retrospective  memory  falsifications  which  slowly  re- 
ceded and  led  to  complete  insight.  Both  patients  were  consid- 
ered incurable,  and  in  the  one  case  the  sudden  appearance  of 
distinct  grandiose  ideas  entirely  in  contrast  with  the  original  per- 
sonality and  mode  of  life  of  the  individual,  reminded  one  of 
hebephrenia,  but  the  patients  remained  active,  mentally  alert, 
always  controlled  the  situation  and  evidenced  neither  manner- 
isms, intelligence  defect  or  emotional  dulness.  The  subacute 
onset  in  relation  to  the  rapidity  with  which  the  entire  situation 
was  reversed  and  the  associated  marked  tendency  toward  mem- 
ory falsifications  are  of  interest  retrospectively  in  contrast  to 
other  chronic  psychoses. 

Bonhofifer  places  these  cases  in  close  relation  with  the  phan- 
tastic  swindlers  and  presents  further  cases  in  which  the  char- 
acteristic feature  is  the  peculiar  transition  between  phantastic 
pseudologia  and  original  delirium.  One  case  had  a  certain  sim- 
ilarity to  chronic  paranoia  for  which  it  had  previously  been 
taken.^  This  similarity,  however,  existed  only  in  so  far  that  the 
delusional  system  had  the  character  of  persecution  and  grandeur. 
The  most  essential  symptom  of  chronic  paranoia,  the  delirium  of 
reference,  however,  played  only  a  subordinate  role ;  the  tendency 
toward  confabulation  was  more  primary,  the  patient  auto-sug- 
gestively  entered  into  his  delusional  ideas. 

In  two  further  cases,  there  appeared  after  an  unpleasant 
prison  life,  peculiar  excitements  which  manifested  themselves  in 
the  production  of  senseless  phantasies,  grandiose  writings  which 
from  the  nature  of  their  origin,  gave  at  first  the  impression  of 
^  This  very  instructive  case  was  again  later  considered  by  Birnbaum  in 
his  "  Psychosen  mit  Wahnbildung  usw." ;  by  Svorcik  in  a  pubhcation  for 
H.  Gross'  Arch.,  XXVIX,  and  lastly  by  Pappenheim  ("  Neuer  Pitaval," 
V,  f.  I  and  2). 

5 


54  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

intended  boasting,  in  their  further  course,  however,  at  times  at 
least,  that  of  auto-suggestions  and  correspondingly  influenced  the 
entire  conduct  of  the  patient.  In  both  patients  the  peculiar  emo- 
tional state  which  was  present,  the  indifterence  and  calm  could 
easily  lead  to  faulty  diagnoses.  Bonhoffer  justly  calls  attention 
to  the  fact  that  in  these  symptoms  we  have  to  deal  with  a  degen- 
erative phenomenon  such  as  is  often  encountered  by  anyone  who 
has  worked  with  habitual  criminals.  Moreover,  a  general  dull- 
ing of  interest  does  not  exist,  much  more  frequently  there  occurs 
a  definite  temporary  activity,  in  the  nature  of  intrigue,  disturb- 
ances of  discipline  and  a  rapid  grasp  of  the  situation,  as  for 
instance,  when  a  possibility  for  escape  presents  itself.  Bonhoffer 
justly  thinks  that  in  these  manifestations  we  are  not  dealing  with 
an  excessively  strained  volitional  effort  expended  upon  the  at- 
tainment of  a  certain  object,  but  with  an  abnormal  state  of  con- 
sciousness, which  may  be  considered  as  the  mildest  grade  of 
auto-somnambulism. 

Bonhoffer  calls  attention  to  the  fact  that  in  the  last  two  cases 
the  development  of  grandiose  ideas  in  immediate  connection  with 
some  vexatious  experience,  or  lack  of  similarity  with  the  so- 
called  typical  disease  forms,  the  unusual  amnesias  which  em- 
brace just  those  unpleasant  features  and  the  prison  milieu,  may 
very  well  suggest  the  suspicion  of  simulation.  He  also  thinks  it 
possible  that  both  patients  have  not  believed  in  their  senseless 
grandiose  delusions  at  first,  although  he  offers  no  further  opin- 
ion whether  there  was  but  a  play  of  phantasy  in  the  production 
of  these  ideas  or  whether  they  were  formulated  with  a  definite 
purpose,  or  again,  something  totally  different.  In  any  case,  the 
later  conduct  of  the  patients  has  indicated  that  delusions,  at 
least  temporarily,  had  become  a  subjective  reality.  This  is  ex- 
plained  through   auto-suggestibility. 

Bonhoffer  characterizes  these  cases  as  degenerative  psychoses 
of  the  form  of  original  paranoia  (Originare  Paranoia).  Gaupp 
in  his  criticism  has  justly  opposed  this  classification  and  referred 


THIRD   PERIOD  55 

in  this  connection  to  the  relation  which  these  cases  hold  to  psy- 
chogenic conditions,  a  much  closer  relation  than  they  bear  to 
paranoia.  In  fact  these  cases  also  show  a  series  of  somatic 
symptoms  such  as  general  hyperalgesia  and  slight  contraction 
of  the  visual  field,  which  are  more  readily  reconciled  with  psy- 
chogenic disorders  than  paranoia. 

Karl  Wilmanns  studied  a  great  number  of  this  group  of  men- 
tal disorders  in  his  review  of  the  prison  psychoses  presented  in 
1907  at  the  38th  Congress  of  the  Southwest  German  Psychiat- 
rists. His  material  included  all  patients  admitted  to  the  Heidel- 
berg Clinic  between  the  years  1891-1906.  These  were  all  cases 
admitted  from  the  prisons  on  account  of  mental  disease  or  for 
observation  in  accordance  with  Paragraph  81  of  the  Code.  In 
addition  to  these  there  were  some  cases  admitted  from  free  life 
who,  on  previous  occasions  while  undergoing  imprisonment,  de- 
veloped a  psychosis.     In  all  two  hundred  and  twenty-seven  cases. 

As  to  the  especial  disease  types  appearing  among  them,  senile 
dementia  was  entirely  absent,  paresis  rare  (6)  ;  cerebral  lues  (i)  ; 
delirium  tremens  (10);  alcoholic  epilepsy  (i).  Symptomatic- 
ally  these  cases  differ  in  no  way  from  the  forms  observed  in  free 
life.  Manic-depressive  insanity  was  only  diagnosed  twice.  Wil- 
manns considered  that  the  rare  occurrence  of  this  disease  form 
among  prison  psychoses  indicates  that  the  manic-depressive  con- 
stitution does  not  lead  to  habitual  criminality. 

The  majority  of  the  cases  (136,  or  49  per  cent.)  belonged  to 
dementia  precox.  Wilmanns  differentiates  here  three  groups: 
(i)  Tramps  who  have  become  asocial  chiefly  as  the  result  of  a 
slowly  progressing  psychosis  or  of  an  acquired  defect  following 
an  acute  disease.  (2)  Habitual  criminals  of  whom  the  majority 
have  been  criminal  for  a  long  time  before  the  disease  had  set  in, 
whereas  in  only  a  few  cases  the  gradually  developing  disease 
process  was  the  cause  of  the  criminality.  (3)  Occasional  crim- 
inals, who,  in  connection  with  the  proceedings,  either  while 
awaiting  trial  or  after  having  been  sentenced,  have  developed 


56  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

mental  disorder.  Wilmanns  cannot  agree  fully  with  the  opin- 
ion of  Siefert  that  the  prison  has  no  causal  significance  in  the 
development  of  the  true  psychoses.  He  believes  that  these  ques- 
tions are  not  to  be  answered  with  certainty  in  the  present  status 
of  our  knowledge  concerning  this  question,  but  he  does  think 
that  from  the  standpoint  of  the  auto-intoxication  hypothesis,  the 
assumption  of  a  causal  connection  between  the  breaking  out  of 
dementia  precox  and  the  demonstrable  markedly  injurious  effect 
of  long  imprisonment  upon  metabolism  cannot  be  disregarded 
without  further  explanation,  because  dementia  precox  appears 
generally  after  years  of  confinement  and  one  can  also  observe  a 
favorable  influence  upon  the  condition  of  the  patient  by  the  re- 
moval from  prison  provided  that  the  psychosis  has  not  already 
advanced  to  the  stage  of  dementia.  In  so  far  as  the  clinical 
picture  is  concerned  in  the  cases  of  dementia  precox  having  an 
acute  onset,  the  effect  of  the  prison  milieu  is  very  evident.  But 
particularly  does  it  color  the  symptomatology  of  the  slowly  be- 
ginning cases.  At  the  time  of  the  initial  change  of  character, 
the  prison  can  call  forth  pictures  which  are  very  difficult  to  dis- 
tinguish from  certain  of  the  functional  psychoses  (querulants, 
delusions  of  innocence,  etc.)  ;  in  such  cases  after  the  transfer  of 
the  patient  to  the  department  for  the  insane,  as  in  degenerates,  a 
subsidence  of  the  disease  symptoms  can  follow,  but  sooner  or 
later,  however,  the  process  advances.  There  are  eleven  (ii) 
cases  of  epilepsy;  these  psychoses  which  originated  in  prison  in 
part  bear  a  typical  epileptic  appearance  and  in  part  show  the 
character  of  psychogenic  disturbances. 

Next  in  frequency  to  dementia  precox,  Wilmanns  found 
among  his  cases,  a  prison  psychosis  which  develops  on  a  basis  of 
degeneracy  (83-63  per  cent.).  The  psychoses  which  develop  on 
this  basis,  he  considers  as  reactions  or  exacerbations  of  abnormal 
predisposition  under  deleterious  influence.  The  degenerative 
prison  psychoses  he  divides  into  acute  and  chronic.  The  former 
develop  preponderantly  during  imprisonment  before  trial,  the 
latter  during  prolonged  imprisonment. 


THIRD    PERIOD  57 

Among  the  acute  forms  various  types  may  be  noted;  they 
form  no  well  defined  pictures  but  symptom-complexes  which  may 
be  associated  with  one  another  in  numerous  ways  and  are  con- 
nected by  many  intermediary  stages.  The  majority  of  these  con- 
ditions appear  before  the  thirty-fifth  year  and  end  usually  with 
complete  insight;  rarely  after  the  subsidence  of  the  disorder,  the 
patients  believe  in  the  reality  of  certain  abnormal  experiences 
which  they  then  endeavor  to  explain  in  accordance  with  their 
habitual  ideation.  The  most  frequent  of  these  acute  forms  are 
the  acute  delirioid  reactions  and  the  Ganser  twilight  state  wath 
its  many  variations  (Racke's  hysterical  stupor,  psychogenic  mu- 
tism without  apparent  clouding  of  consciousness).  Further- 
more there  develop  transient  psychotic  disturbances  which  ap- 
parently arise  from  hypnagogic  hallucinations.  Terrifying  hallu- 
cinations accompanied  by  anxiety;  all  sorts  of  nervous  complaints 
and  at  times  also,  mild  dreamlike  confusions,  set  in.  All  these 
appear  during  the  night.  If  the  imprisonment  is  not  quickly  ter- 
minated it  may  lead  to  severe  persistent  disturbance.  Acute 
paranoid  pictures  with  phantastic  delusions  which  change  the 
individual's  own  personality,  such  as  Bonhoffer  has  described, 
Wilmanns  has  likewise  met  with;  he  refers  their  origin  to  auto- 
hypnotic  states.  Finally  he  describes  acute  psychoses  with  nu- 
merous plastic  hallucinations,  complete  retention  of  consciousness 
and  an  anxious  irritable  affect,  forms  which  strongly  remind  one 
of  alcoholic  paranoia. 

These  acute  states  stand  in  opposition  to  the  chronic  degener- 
ative prison  psychoses.  Under  the  lasting  influence  of  the  monot- 
onous sameness  of  years  of  imprisonment,  particularly  years 
of  solitary  confinement,  delusional  ideas  appear  and  from  these 
chronic  psychoses  may  develop.  Wilmanns  maintains  that  ac- 
cording to  the  individual  predisposition,  there  may  develop  either 
phantastic  day  dreaming  or  hypochondriacal  depressions,  both 
degenerative  psychotic  conditions  just  as  they  are  observed  in 
free  life.     On  the  other  hand  the  persecutory  content  of  the 


58  THE    HISTORY   OF    THE   PRISON    PSYCHOSES 

delusions  is  typical  of  inmates  of  prisons.  In  an  individual  fun- 
damentally suspicious  and  inclined  to  an  exaggeration  of  the 
Ego,  or  even  in  those  with  an  abnormally  small  degree  of  egotism, 
there  develop,  in  a  way  characteristic  of  the  habitual  criminal, 
prejudicial  ideas  w^ith  reference  to  the  officials  of  law  and  the 
prison  personnel,  which  attach  themselves  to  experiences  usually 
insignificant  but  which,  owing  to  the  uniformity  of  the  prison 
life,  are  more  closely  observed  and  through  suspicious  broodings 
exaggerated.  In  this  manner  are  formed  delusions  which  may 
remain  isolated  or  develop  into  a  delusional  system  of  the  most 
varied  latitude.  The  characteristic  type  of  these  chronic  para- 
noid prison  psychoses  is  the  querulant  form.  After  removal  to 
a  hospital  the  further  development  of  the  delusions  usually  stops, 
and  if  the  patient  is  freed,  the  abnormal  ideas  lose  all  influence 
upon  the  individual's  conduct. 

Wilmanns  discusses  thoroughly  the  clinical  position  of  these 
degenerative  chronic  paranoid  prison  psychoses.  They  are  dis- 
tinguished from  the  paranoia  and  litigious  paranoia  of  Kraepelin 
only  in  their  prognosis.  Yet  these  forms,  according  to  Wil- 
manns' opinion,  are  clinically  exactly  alike,  but  those  developing 
in  free  life  "  are  the  results  of  a  more  profound  degeneracy  than 
those  which  develop  in  imprisonment  which  may  be  considered  as 
a  product  of  degeneracy  plus  external  removable  factors." 

All  of  the  chronic  forms  of  degenerative  prison  psychoses 
may  be  com'bined  in  the  most  manifold  way  with  transient  or 
more  protracted  acute  manifestations,  such  as  the  numerous  hal- 
lucinations, anxiety  states,  etc.  Thus  forms  may  develop  which 
in  their  symptomatic  variation  remind  one  of  the  picture  of  de- 
mentia precox.  But  the  course  is  in  all  of  these  polymorphous 
forms  more  or  less  the  same;  in  the  great  majority  of  cases  a 
favorable  change  in  the  environment  produces  a  standstill  in  the 
course  of  the  disease.  Almost  all  patients  in  time  have  insight 
into  the  pronounced  disease  manifestations  but  cling  to  the 
slowly  developed  ideas  of  prejudice,  particularly  when  these  have 


THIRD    PERIOD  59 

the  same  trend  as  the  suspicious  ideas  which  are  very  common 
among  the  habitual  criminals,  concerning  the  nature  of  impris- 
onment and  its  relation  to  society  in  general. 

A  comparison  of  Wilmanns'  cases  with  regard  to  their  origin 
(workhouse,  detention  prison,  penitentiary),  shows  strongly  a  pre- 
ponderance of  the  degenerative  psychoses  in  the  detention  prison 
{62  per  cent.)  as  compared  with  those  from  the  workhouse  (20  per 
cent.)  and  those  from  the  penitentiary  (18  per  cent.).  The  prison 
psychoses  are  unquestionably  much  more  frequent  in  the  peni- 
tentiary than  these  figures  would  indicate,  but  the  patients  in 
question  remain  for  the  most  part  in  the  hospitals  of  the  peniten- 
tiaries. Dementia  precox  was  diagnosed  among  the  prisoners 
awaiting  trial  in  only  19  per  cent.,  in  those  from  the  workhouse 
in  61  per  cent,  and  in  those  in  penitentiaries  in  68  per  cent.  The 
relative  rarity  of  the  degenerative  psychoses  in  the  workhouse, 
Wilmanns  attributes  to  the  preponderant  frequency  of  high 
grade  imbeciles  among  the  paupers,  to  the  more  advanced  age  of 
most  inmates  of  the  workhouse,  and  to  the  great  frequency  of 
chronic  alcoholics  and  the  rarity  of  hysterical  predisposition  in 
these,  and  finally  to  the  practice  of  mass-confinement  in  the 
workhouse. 

A  substantial  broadening  and  deepening  of  our  knowledge 
of  the  degenerative  prison  psychoses  was  brought  about  by  K. 
Birnbaum.  Birnbaum  describes  in  his  monograph  in  1908 
"  Psychosen  mit  Wahnbildungen  und  Wahnhafte  Einbildungen 
bei  Degenerationen."  Although  in  the  description  and  analysis 
of  these  forms,  the  general  clinical  interest  stands  throughout  in 
the  foreground,  the  consideration  of  the  work  is  justified  here, 
in  that  all  patients  of  Birnbaum  were  criminals  and  with  few 
exceptions  had  become  ill  while  in  prison.  The  author  groups 
his  cases  according  to  the  following  fundamental  scheme:  on  an 
already  existing  psychopathic  foundation,  there  develops  from 
some  cause  or  other — as  was  mentioned  nearly  all  patients  be- 
came ill  while   in  prison — a  disorder  in  which   the  delusional 


60  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

fabric  is  essentially  restricted  to  a  well  coordinated  system;  this, 
in  contrast  to  paranoia  is  not  permanent,  but  recedes  sooner  or 
later  from  varying  causes  and  gives  place  to  the  former  average 
norm.  The  content  is  of  prejudicial  ideas,  of  phantastic,  gran- 
diose ideas  in  inexhaustible  variety,  delusional  memory  falsifica- 
tions, peculiar  free  phantasy  percepts  of  indifferent  content. 
Hallucinations  of  all  senses  appear  but  mostly  are  of  secondary 
import  as  compared  with  the  compass  and  frequency  of  the  de- 
lusional element.  The  scope  and  construction  of  the  delusional 
picture  change  extraordinarily.  Now  extensive  delusional  ele- 
ments exist,  again  only  a  few  delusional  complexes  and  finally 
only  isolated  ideas.  Occasionally  the  isolated  elements  form  a 
quite  uniform  delusional  complex,  so  that  relatively  pure  forms 
of  grandiose  and  prejudicial  deliria  arise.  Frequently  however, 
are  found  delusional  admixtures  of  an  indifferent  content.  Often 
the  gross  picture  is  formed  by  the  juxtaposition  of  altogether 
different  kinds  of  delusional  products:  hypochondriacal,  grandi- 
ose and  persecutory  ideas  may  be  found  associated.  Even  self- 
contradictory  ideas  may  occur  simultaneously  without  being  cor- 
rected. All  these  delusional  formations  are  very  superficial,  de- 
termine very  little  the  conduct  of  the  patient,  are  inconstant  and 
easily  modified.  They  also  arise  in  a  manner  altogether  dif- 
ferent from  that  of  the  true  paranoid  delusions,  that  is,  in  an 
auto-suggestive  manner;  they  therefore  represent  in  many  re- 
spects the  subjective  realization  of  the  patient's  wishes,  similarly, 
as  in  other  instances,  they  repress  unpleasant  concepts.  Dis- 
turbances of  consciousness  appear  frequently,  especially  in  the 
beginning  of  the  psychoses;  they  not  infrequently  have  the  ap- 
pearance of  hysterical  disturbance  of  consciousness  (stupor,  the 
Ganser  symptom-complex,  twilight  states).  The  course  of 
these  delusional  psychoses  shows  no  regularity.  All  components 
of  the  course  are  determined  essentially  by  outer  influencel. 
Very  frequently  the  psychoses  set  in  without  apparent  premoni- 
tion.    The  delusional  system  may  from  the  beginning  be  complete 


THIRD   PERIOD  6 1 

and  may  confine  itself  to  the  ideas  elaborated  at  the  onset,  or  new 
ideas  may  attach  themselves,  or  again,  the  delusions  may  alter 
kaleidoscopically.  The  cessation  of  the  process  occurs  gradually 
as  a  rule.  The  former  condition  of  the  individual  usually  is 
again  reached.  Not  always  is  complete  insight  gained;  it  is 
not  rare  that  delusional  remnants  remain  but  without  influence 
upon  the  psychic  conduct.  The  prejudicial  ideas,  especially,  re- 
main uncorrected  for  a  time;  and  particularly  do  such  persons 
firmly  retain  their  phantastic  delusional  conceptions  who,  orig- 
inally, showed  a  tendency  to  the  formation  of  phantastic  views  con- 
cerning things  in  general.  The  entire  course  of  these  psychoses, 
as  well  as  the  symptomatology,  shows  multiform  variations.  Rel- 
atively the  most  frequent  are  the  "  simple  forms  "  in  which  there 
occurs  a  simply  unfolding  of  the  delusional  fabric.  Along  with 
this,  the  combined  forms  not  infrequently  occur  and  indeed,  the 
number  of  separate  combinations  is  so  great  that  their  possibil- 
ities can  scarcely  be  exhausted.  Still  the  principal  types  can  be 
dififerentiated  as  recidivous,  remittent  and  intermittent.  But  all 
these  classifications  do  not  touch  the  nature,  rather  only  the 
outward  manifestation  of  the  disease  process.  The  combined 
forms,  for  example,  come  into  existence  through  the  manifold 
variations  in  the  disease  process,  exacerbations  and  remissions 
and  changing  of  the  delusional  ideas.  There  are  also  cases, 
which  because  of  an  unusually  long  duration,  appear  as  chronic ; 
still  here  too,  the  susceptibility  to  external  factors,  the  variabil- 
ity and  superficiality  of  the  delusional  formation  is  characteristic. 
The  duration  of  the  psychosis  varies  from  case  to  case  inside  of 
wide  limits,  amounting  to  a  few  days  or  weeks  or  months.  In 
the  combined  types  the  process  may  extend,  usually  with  varia- 
tions, over  years,  even  decades ;  even  then  the  long  continued  de- 
lusional formation  remains  capable  of  retrogression  and  varia- 
bility, this  being  made  particularly  noticeable  by  decided  occur- 
rences only,  e.  g.,  upon  the  patient's  admission  to  a  prison  or 
hospital. 


62  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

The  essential  characteristics  of  the  degenerative  psychoses, 
that  is,  the  extraordinary  determinability  and  susceptibility  to  in- 
fluence by  external  factors,  the  character  and  the  psychological 
mode  of  development  of  the  delusions,  etc.,  may  be  referred  in 
general  to  the  essential  characteristics  of  the  degenerative  per- 
sonality :  to  the  exaggerated  auto-suggestibility,  the  great  lability 
of  conditions  and  mental  pictures  as  they  may  exist  at  any  given 
moment,  to  the  disproportion  between  emotive  and  imaginative 
activity  and  to  the  preponderance  of  an  active  phantasy  over 
common  sense.  Thus  these  psychoses  develop  obviously  in  such 
individuals  upon  an  abnormal  soil.  According  to  Birnbaum  they 
do  not  constitute  a  disease  process  of  characteristic  kind  but 
rather  are  episodic  psychotic  phenomena  arising  from  a  degener- 
ative basis  and  the  various  phases  of  combined  types  are  to  be  re- 
garded as  repeated  vacillations  in  the  psychic  equilibrium. 

The  beginning  of  these  psychoses  occurs  quite  regularly  in 
the  third  decade.  Birn'baum  thinks  that  this  circumstance  is  ref- 
erable especially  to  the  entrance  of  the  individual  concerned 
upon  life  which  occurs  at  this  time  and  in  whom  as  a  rule,  it  at 
once  brings  about  severe  mental  upsets.  One  cannot  altogether 
agree  with  him  in  this  point.  Although  this  external  moment 
cannot  be  neglected  yet  doubtless  the  real  cause  of  this  temporal 
relation  undoubtedly  lies  still  deeper,  namely,  in  the  inherent  tend- 
ency of  youth  to  that  variety  of  psychic  disturbances.  It  has 
its  analogy  in  the  generally  recognized  preponderant  tendency  of 
youth  to  hysterical  psychoses,  whose  close  relationship  with  the 
forms  which  he  describes,  Birnbaum  himself  emphasizes.  This 
relationship  reveals  itself  in  general  in  .the  chief  characteristics 
of  hysteria  and  Birnbaum's  degenerative  psychoses,  in  the  far 
reaching  similarity  in  both  forms  of  the  basic  elements,  in  the 
frequent  appearance  of  the  same  symptoms  in  both  and,  finally, 
in  that  the  same  individual  not  rarely  has  been  attacked  at  one 
time  by  a  degenerative  psychosis  and  at  another  by  an  hysterical 
disorder.     Thus  all  attempts  to  separate  these  types  from  one 


THIRD   PERIOD  63 

another  are  artificial,  whereas,  all  differential  difficulties  are  re- 
moved if  one  includes  the  hysterical  mental  disorders  among  the 
degenerative  psychoses. 

As  mentioned,  most  of  Birnbaum's  cases  are  prison  psychoses. 
Birnbaum  shows  in  regard  to  this  that  it  does  not  concern  specific 
prison  influences.  The  prison  milieu  can  admittedly  influence  the 
content  of  the  delusional  ideas  and  be  decisive  for  the  complexes 
which  are  to  develop;  analogous  disease  forms  appeared,  how- 
ever, under  conditions  lacking  the  prison  influence. 

While  the  above  cited  investigators  of  degenerative  insanity 
have  argued  for  the  inner  relationship  and  impossibility  of 
sharper  differentiation  between  the  hysterical,  psychogenic  and 
degenerative  disorders,  Risch  endeavors  in  his  work  upon  the 
phantastic  form  of  degenerative  insanity,  to  differentiate  this 
sharply  from  hysteria  as  a  definite  disease  type,  however,  without 
convincing  effect.  In  another  work  in  which  he  sought  by  the 
usual  methods  to  separate  the  acute  prison  psychoses  ( forms  with 
speech  and  motor  inhibition,  with  transient  and  slightly  prom- 
inent visual  hallucinations)  from  the  results  of  psychic  traumata 
as  ordinarly  observed,  he  separates  hysterical  and  psychogenic 
psychoses  from  one  another.  He  thinks  that  those  psychogenic 
deliria  without  hysterical  stigmata  originating  in  prison  are  to  be 
considered  more  favorable  than  the  "  hysterical "  deliria  as  far 
as  the  fitness  for  re-imprisonment  is  concerned;  in  the  number 
of  the  hysterical  stigmata  present,  Risch  saw  almost  a  measure 
of  the  severity  of  the  disturbances,  and  also,  with  regard  to  the 
question  of  responsibility  for  the  act,  he  establishes  differences 
between  hysterical  and  simple  psychogenic  disturbances — opin- 
ions which  are  certainly  unconvincing  and  also  for  which  Risch 
furnishes  no  proof. 

Riidin  published  in  1909  the  last  large  work  on  this  subject 
"  On  the  Clinical  Forms  of  Mental  Disturbances  in  Life  Pris- 
oners." He  worked  with  a  still  little  known  and  highly  interest- 
ing material  and  advanced  not  only  our  knowledge  of  the  prison 


64  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

psychoses  alone,  but  also  of  the  psychogenic  disturbances  in  gen- 
eral, especially  of  those  forms,  the  study  of  which  probably  will 
still  furnish  us  important  clinical  information. 

Riidin  examined  forty-seven  murderers,  originally  condemned 
to  death  but  pardoned  to  life  imprisonment,  who  had  been 
placed  in  the  insane  department  at  Moabit  on  account  of  mental 
disorder.  Because  of  the  severity  and  the  lifelong  duration  of 
the  imprisonment  to  which  these  people  were  sentenced,  psy- 
chiatric studies  of  them  are  of  particular  interest.  According  to 
the  experience  of  prison  physicians  there  are  found  among  mur- 
derers, as  Riidin  says,  eccentric  individuals,  psychopaths  and 
degenerates  in  still  greater  number  than  in  the  average  classes 
of  other  criminals,  and  according  to  Riidin,  Leppmann  states 
that  "  life  prisoners "  all  at  some  time  or  other  show  mental 
symptoms,  i.  e.,  they  develop  mental  disorder  of  a  greater  or  less 
degree. 

To  the  clinical  picture  of  the  mental  disturbances  of  the  life 
prisoners,  without  reference  to  the  clinical  forms,  belong  sev- 
eral characteristic  features,  fixed  delusional  conceptions  "which 
can  only  be  explained  by  the  peculiar  nature  of  the  dishonorable 
punishment  and  life  imprisonment."^  Most  frequent  is  the  de- 
lusion of  innocence;  almost  as  characteristic  is  the  delusion  of 
pardon  or  discharge.  The  latter  has  usually  associated  with  it 
still  other  exacting  ideas,  hallucinations  and  delusions  of  wish 
fulfilling  character.  "  Quite  often  we  have  to  deal  here  with 
repressive  manifestations  of  oppressive,  unpleasant  ideas  or  com- 
plexes developing  psychologically  under  the  stress  of  a  persistent, 
gnawing  affect,  a  manifestation  which  we  likewise  observe  not 
infrequently  in  healthy  individuals,  psychopaths  and  the  insane 
under  conditions  of  lesser  stress,  an  occurrence,  which  though 
supported  by  other  ideas  in  a  certain  measure  forming  the 
*  We  meet  here  with  a  relation  which  previous  writers  studying  the 
prison  psychoses  have  found :  the  distinctive  prison  milieu  casts  over  the 
most  varied  clinical  forms  of  mental  disorders  which  happen  to  develop 
in  it,  a  common  coloring. 


THIRD   PERIOD  65 

counterpart,  takes  place  through  the  clinging  to  the  ardently  pre- 
served hope  of  release  or  pardon,  a  hope  always  associated  with 
a  strong  affect  and  readily  assimilating  both  false  and  true  ideas 
in  its  substantiation."  Finally  insane  life  prisoners  without  re- 
gard to  the  disease  type,  strikingly  often  appear  to  have  aged 
early. 

In  regard  to  the  isolated  disease  forms,  Riidin  found  that  as 
with  other  prisoners,  with  life  prisoners  also,  dementia  precox  was 
the  most  frequent  (21  of  47  cases),  that  manic-depressive  in- 
sanity, which  is  generally  very  rare  in  prisoners,  was  altogether 
absent.  Four  patients  were  epileptics,  nine  had  psychogenic  psy- 
choses (among  which  two  were  hysterical  and  four  developed 
on  the  basis  of  "  epileptoid  degeneracy")  ;  one  case  was  a  psy- 
chosis associated  w^ith  progressive  deafness  and  imhecility ;  four 
patients  suffered  with  litigious  paranoia;  two  from  paranoia 
(Verriicktheit)  ;  six  from  "presenile  pardon  delirium  (Begnadi- 
gungswahn)  of  life  prisoners." 

Riidin  found  in  his  dementia  precox  cases  "  that  the  delusions 
of  innocence  and  pardon  so  characteristic  of  all  life  prisoners  oc- 
curred in  some  in  pronounced  form  but  once,  in  others  they  dis- 
appeared and  returned,  while  in  still  others  they  permanently 
dominated  the  disease  picture,  while  the  hebephrenic  character- 
istics were  not  in  the  least  obscured";  occasionally  also  a  delu- 
sional interpretation  of  the  criminal  act  as  a  requisite  for  the  ful- 
filling of  a  religious  mission  was  found.  Thus  typical  disease 
pictures  generally  bore  symptomatically  in  great  measure  the 
stamp  of  the  peculiar  fate  and  the  peculiar  surroundings  of  life 
prisoners.  One  of  the  patients,  a  wife  murderer,  was  especially 
interesting.  He  was  already  recognized  to  be  mentally  diseased 
at  forty,  seven  years  before  entrance  upon  the  life  sentence.  At 
fifty-one  he  showed  a  pronounced  Delbriick  symptom-complex. 
Gradually  the  mental  disintegration  progressed  to  a  condition  of 
confusion  and  advanced  dementia.  At  the  time  of  the  observa- 
tion he  was  seventy-six  and  at  least  thirty-six  years  after  the 


66      ■  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

beginning  of  the  psychosis  palpable  signs  of  senile  dementia  and 
senile  confusion  were  recognizable.  Riidin  considers  here  the 
clinical  similarity  of  the  Delbriick  symptom-complex  to  cata- 
tonia, with  termination  in  catatonic  dementia  and  confusion  and 
later  the  development  of  senile  dementia,  as  evident. 

The  four  cases  of  epileptic  psychoses  differ  in  general  but 
little  from  types  of  this  disease  seen  in  free  life.  Among  some 
of  these,  as  is  often  enough  the  case  in  free  life,  psychogenic  fea- 
tures are  mingled  and  for  the  rest,  they  bear  the  stamp  of  the 
peculiar  fate  of  the  patient. 

The  remainder,  i.  e.,  twenty-two  of  forty-seven  cases  are 
clearly  psychogenic  in  origin  or  are  types  of  psychoses  showing 
a  marked  psychogenic  coloring.  Among  the  clearly  psychogenic 
forms,  Riidin  describes  first,  as  unusual  types  of  cases,  those 
whose  clinical  classification  he  cannot  determine  with  certainty. 
A  certain  affect  duling,  marked  development  of  hallucinations, 
slight  susceptibility  of  symptoms  to  change  of  milieu  reminds 
one  of  dementia  precox;  still  the  principal  symptoms  of  this  dis- 
ease are  not  present  in  significant  degree ;  the  disease  picture 
permits  a  specific  personal  predisposition  to  be  presupposed  and 
bears  the  stamp  of  the  sad  surrounding  and  the  harsh  fate. 
Thus  it  seems  to  Riidin  most  natural  to  assume  that  the  three 
cases  are  "  psychogenic  results  which  hopeless  imprisonment  has 
occasioned."  We  are  dealing  here  with  truly  characteristic  pic- 
tures which  essentially  differ  from  the  forms  which  Birnbaum 
has  described  above  all  by  the  immutability,  fixity  and  slight 
susceptibility  to  outer  influence  of  the  symptoms.  Particularly 
the  third  of  the  three  patients  is  noteworthy.  A  man  of  limited 
ability,  accused  of  murder,  while  awaiting  trial  suffered  from  an 
attack  of  hallucinatory  stupor  without  demonstrable  clouding 
of  consciousness.  He  made  changing,  contradictory  statements 
in  regard  to  his  crime  and  attempted  suicide  after  sentence. 
Later  his  condition  was  variable,  now  clear,  now  lost  in  dreams, 
indifferent,  once  mute  for  an  entire  year.     With  the  cessation  of 


THIRD    PERIOD  6/ 

this  mutism  the  patient  showed  an  amnesia  for  his  sentence  and 
crime  and  "by-speaking"  (Vorbeireden)  ;  later  he  developed  the 
delusion  that  the  state  attorneys,  judges  and  doctors  conspired 
against  him ;  he  showed  a  good  memory  for  all  factors  favorable 
to  him,  amnesia  on  the  contrary  for  the  crime  and  everything  op- 
pressive to  him,  along  with  an  otherwise  good  memory.  Riidin 
explains  the  case,  doubtless  correctly,  in  the  following  manner : 
the  patient  carries  on  a  stubborn,  continuous,  conscious  and  un- 
conscious struggle  against  the  effects  which  the  murder  has  upon 
his  conscience  and  fate.  At  first  he  is  still  uncertain  but  always 
succumbs  again  and  again  to  those  abnormal  expressions  of 
mental  and  physical  torpidity  which  so  frequently  develop  in 
connection  with  "  powerful  psychogenic  stimuli,"  and  finally  finds 
his  mental  equilibrium  through  incessant  brooding  and  uncon- 
scious repression  of  all  factors  which  oppress  his  conscience,  thus 
he  succeeds  "with  full  conviction  to  replace  actual  occurrences 
with  a  tissue  of  delusional  ideas,  in  which  he  himself  is  no  longer 
a  justly  punished  criminal  but  an  innocently  persecuted  individual." 
Perhaps  this  person  would  never  have  come  into  contact  with  the 
psychiatrist,  had  he  not  received  the  severe  punishment. 

Along  with  these  three  cases  Riidin  considers  two  hysterical 
psychoses,  four  cases  of  "  psychoses  on  the  basis  of  epileptoid 
degeneracy"  as  true  psychogenic  psychoses.  Under  the  latter 
title  Riidin  describes  psychoses  which  in  their  course  clearly  re- 
semble epilepsy  but  of  which  the  origin  either  entirely,  or  prepon- 
derantly, is  psychogenic.  Hysterical  stigmata  and  a  decided  hys- 
terical character  are  absent,  also,  isolated  symptoms  are  in  much 
slighter  degree  susceptible  to  influence  than  in  the  hysterical  psy- 
choses. On  the  other  hand,  the  characteristics  of  the  classical 
epileptic,  convulsive  attacks,  typical  deterioration  with  dullness, 
circumstantiality,  etc.,  are  absent.  On  the  contrary,  some  symp- 
toms remind  one  strongly  of  epilepsy,  such  as  a  certain  periodicity 
and  brutality ;  the  fact  that  alcoholism  and  epilepsy  are  frequently 
found  in  close  association  in  such  patients  shows  its  close  relation 
to  epilepsy. 


68  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

Also,  the  case  of  psychosis  associated  with  progressive  deaf- 
ness and  imbeciHty  Riidin  places  with  the  psychogenic  forms,  but 
is  of  the  opinion  that  we  can  first  gain  a  closer  knowledge  of  such 
psychoses  associated  with  deafness  after  collecting  a  largernumber 
of  these  cases, 

Riidin  looks  upon  the  litigious  paranoia  in  agreement  with 
other  authors  as  "  a  definite  paranoid  form  of  reaction  of  a  definite 
psychopathic  predisposition  to  definite  external  vicissitudes  of  life, 
perhaps  favored,  brought  out  or  made  possible,  by  definite  dispo- 
sitions associated  with  age,  sometimes  by  crises  of  a  physical  na- 
ture, sometimes  by  a  reduction  of  the  general  constitutional 
resistance  of  the  organism  through  debilitating  diseases  and  in- 
somnia, with  more  or  less  pronounced  restitution  under  favorable 
environmental  conditions."  The  four  patients  of  Riidin  who  be- 
longed to  the  form  of  chronic  litigious  paranoia  with  delirium  of 
innocence  all  show  originally  the  characteristic  querulant  predis- 
position. Riidin  is  of  the  opinion  that  the  physician,  in  these  cases 
which  according  to  their  previous  history  are  susceptible,  must 
recommend  their  discharge  in  the  earlier  stages  of  the  disease,  in 
order  to  obtain  their  cure.  In  life  prisoners  who  develop  litigious 
paranoia,  the  possibility  of  restitution  is  particularly  limited,  for 
the  extremely  severe  trauma  and  the  otherwise  unfavorable  situa- 
tion of  the  prisoner  makes  a  return  to  normal  conditions  very 
difficult. 

After  a  description  of  two  chronically  insane  patients,  Riidin 
finally  describes  the  presenile  delirium  of  prejudice  (Beeintrachti- 
gungswahn)  of  life  prisoners.  This  peculiar  disease  picture  de- 
scribed by  him  for  the  first  time  develops  in  prematurely  aged 
prisoners,  who  up  to  that  time  had  behaved  themselves  well  in 
prison  life.  Quite  suddenly  the  delusional  conviction  of  being 
pardoned  appears.  With  it  are  associated  vivid  hallucinations, 
particularly  auditory  hallucinations  of  which  the  content  is  encour- 
aging, but  there  may  also  be  a  disturbing  and  frightful  content. 
The  delusion  is  unshakable,  is  based  upon  a  naive,  childlike  rea- 


THIRD   PERIOD  69 

soning,  but  remains  well  within  the  limits  of  the  possible,  is  not 
confused  and  bizarre;  the  systematization  does  not  reach  very  far. 
Orientation  and  consciousness  remain  intact,  the  behavior  is  or- 
derly and  natural.  And  although  they  plead  with  great  emotivity 
their  right  to  freedom,  and  also,  as  a  consequence  subsequently 
they  refuse  to  work,  they  show  usually,  a  quiet,  approachable  and 
indulgently  gentle  attitude.  They  are  not  irritated  by  arguments, 
although  these  may  be  contrary  to  their  delusional  beliefs.  Riidin 
considers  this  disease  as  psychogenic,  as  a  result  of  the  permanent 
trauma  together  with  the  severe  fate  of  life  prisoners,  without, 
however,  denying  the  fact  that  the  premature  senescence  of  the 
brain,  an  essential  factor  predisposing  to  disease,  is  general  with 
these  prisoners.  In  all  cases  the  disease  first  appeared  in  advanced 
age,  between  the  forty-fifth  and  sixty-third  years;  all  patients 
seem  to  be  prematurely  changed  physically,  and  some  of  them 
show  a  certain,  although  not  very  pronounced  weakness  of  mem- 
ory, perceptive  disturbances,  a  pitiable,  childlike  unwieldiness  of 
thinking.  This  predisposing  influence  of  premature  senility  Riidin 
does  not  consider  more  important  than  the  degenerative  predis- 
position of  a  juvenile  degenerate  who  develops  a  prison  complex; 
neither  would  have  become  ill  had  they  not  come  into  contact  with 
the  harm  fulness  connected  with  the  prison.  This  form  of  dis- 
order must  be  differentiated  from  the  senile  persecutory  delirium 
although  a  certain  relation  exists  between  the  two ;  the  conduct  of 
the  patients  suffering  from  "  the  presenile  delirium  of  pardon  "  is 
more  orderly,  their  attitude  is  more  accessible  and  more  pliant 
than  we  observe  in  patients  with  senile  persecutory  delirium;  in 
addition  to  this  the  cases  of  Riidin  appeared  in  early  age,  develop- 
ing comparatively  rapidly,  and  further,  the  delusional  ideas  are 
fixed,  not  confused  and  disconnected  as  in  senile  persecutory 
delirium. 

In  a  statistical  work,  the  last  appearing  on  our  subject,  Kurt 
Wilmanns  finds  in  two  hundred  and  twenty  cases  from  the  Bonn 
Clinic,   that  two   distinct,   separate   symptom-complexes   appear, 

6 


yO  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

which  he  believes  may  be  considered  prison  psychoses,  a  stuporous 
type  representative  of  mass-imprisonment  and  a  paranoid  type,  as 
the  form  of  solitary  confinement.  These  psychoses  develop  more 
readily  in  degenerates  and  in  the  mentally  disordered  than  in  the 
mentally  normal.  The  work  is  wholly  statistical,  and  all  clinical 
comments  are  lacking.  Therefore,  one  is  unable  to  consider,  and 
particularly  to  judge,  these  important  results  as  the  author  sepa- 
rates both  types,  as  he  also  has  attempted  to  do  in  dementia  precox, 
from  the  symptom-complex  of  the  fundamental  disease  altogether 
without  consideration  of  the  fact  that  the  differentiation  of  stupor- 
ous and  paranoid  forms,  where  both  are  so  intimately  mingled 
must,  in  many  cases,  be  purely  arbitrary. 


CONCLUSIONS 

The  study  of  the  literature  on  the  prison  psychoses  from  Del- 
briick  to  the  present  time,  on  account  of  the  contradictory  results 
of  the  numerous  works  is  often  discouraging  and  fatiguing.  Fol- 
lowers of  the  various  schools  have  tried  to  solve  the  question  and 
the  psychiatric  conceptions  with  which  they  approach  the  work  are 
so  many  and  contradictory,  that  it  is  difficult  to  consider  the  result 
from  any  one  standpoint.  Almost  all  authors  form  their  opinions 
from  the  study  of  the  disease  material  to  which  they  have  access, 
without  comparing  them  critically  with  the  opinions  of  their  prede- 
cessors. The  few  who  do  this,  scarcely  question  that  the  wide 
disagreement  between  their  own  and  earlier  studies  is  to  be  re- 
ferred to  a  probable  dissimilarity  in  the  material  studied.  Thus 
the  most  variable  material  has  served  the  students  of  this  subject 
as  the  fcanaai.''in  of  conclusions  to  which  they  would  assign  a 
general  validity,  ^hus  they  sought  to  solve  the  question  of  the 
prison  psychoses  in  p^'soners,  who  during  short  imprisonment  or 
after  long  confinement,  develop  a  mental  disorder  in  peniten- 
tiaries, in  mentally  diseased  -eformatory  inmates,  in  those  showing 
acute  mental  disorders  while  c  waiting  trial,  in  the  chronic  insane 
in  the  asylums.  As  the  authors  must  come  to  contradictory  con- 
clusions on  the  ground  of  such  va-ied  material  and  as  the  present 
ideas  concerning  the  prison  psycho  ^>es  have  developed  from  this 
chaos  of  contradictory  opinions,  a  f e  v  comments  should  be  made 
here  concerning  them. 

We  have  separated  our  review  into  three  parts.  The  first  em- 
braces the  works  of  the  old  school,  the  .econd  considers  the  ques- 
tion of  prison  psychoses  from  the  stant'ooint  of  Kraepelin's  con- 
ception of  dementia  precox,  and  the  thi  d  from  the  standpoint  of 
the  Magnan-Mobius  ideas  on  degeneracy 

The  first  period  is  especially  charac  ;erized  by  the  works  of 

71 


72  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

Delbriick,  Gutsch,  Sommer  and  Kirn.  The  cases  which  Delbriick 
sought  to  describe  under  his  "  criminal  insanity  "  were  the  chronic 
dementing  psychoses.  This  finds  its  explanation  in  the  character 
of  the  material  which  served  as  the  basis  for  his  observations. 
The  fact  that  the  house  of  correction  at  Halle  served  as  the  outlet 
for  other  prison  institutions  which  preferred  to  transfer  their 
insane  or  otherwise  undesirable  inmates  there,  as  well  as  the  fact 
that  this  institution  was  meant  exclusively  for  the  worst  criminals 
sentenced  to  long  terms,  among  whom  the  chronic  psychoses  in 
the  course  of  time  naturally  often  occur,  permits  of  the  conclusion 
that  the  progressive  incurable  disease  processes  must  have  gath- 
ered there.  It  is  therefore  not  surprising  that  the  physician  who 
had  for  years  been  in  this  prison  service  should  have  been  espe- 
cially attracted  by  the  development  under  his  own  eyes  of  these 
disturbances  with  their  manifold  and  variable  pictures.  The  nat- 
ural result  was  that  Delbriick  considered  the  relatively  rare  acute 
psychoses  either  as  episodes  in  the  slowly  developing  processes,  or, 
in  accordance  with  the  then  greatly  overestimat'-J  trcquency  of 
the  occurrence  of  simulation  of  mental  disease,  explained  them  as 
simulation.  The  description  which  Delb':ack  gave  us  of  these 
progressive  psychoses,  contains,  howevei-,  many  pertinent  observa- 
tions. But  on  the  other  hand,  his  theory  misled  him  to  an  inac- 
curate psychologically  unexplainable  and  unanalyzable  description 
of  the  development  of  the  disea  ^e,  in  that  he  believed  that  in  the 
criminal  by  passion,  it  is  the  remorse  for  the  deed,  and  in  the 
habitual  offender  against  pro  4erty,  it  is  the  result  of  the  derange- 
ment of  his  bodily  and  men/al  health  through  his  criminal  career 
which  causes  him  to  fall  p  rey  to  mental  disturbances. 

While  Delbriick  has  gi,v^en  us  the  first  description  of  dementia 
precox  developing  in  pri;ion,  the  interest  of  Gutsch  has  centered 
in  altogether  different  ca  ^es.  The  prison  at  Bruchsal  where  soli- 
tary confinement  is  the  r tile,  does  not  serve  as  the  outlet  for  other 
prisons  and  the  acute  mc  htal  disturbances  play  a  larger  role  among 
the  numerous  newcomeVs  than  in  Halle.     The  prognosis  of  the 


CONCLUSIONS  73 

mental  disturbances  in  Bruchsal  was  naturally  more  favorable,  a 
large  number  of  patients  recovered  while  still  in  prison  and  re- 
mained well  in  freedom,  as  the  catamnestic  researches  of  Gutsch 
showed.  Thus  Gutsch  fell  into  the  opposite  error.  While  Del- 
briick  explained  the  relatively  small  number  of  acute  symptoms 
among  his  cases  as  the  forerunners  of  his  "  criminal  insanity," 
Gutsch  from  his  observation  of  the  frequency  of  recovery  from 
the  melancholia  of  solitary  confinement,  underestimated  the  num- 
ber of  the  prognostically  unfavorable  forms. 

On  looking  over  the  material  of  Delbriick,  it  is  evident  that  it 
decidedly  opposes  the  independency  of  the  melancholia  of  Gutsch 
which  is  considered  but  a  transient  developmental  stage  of  his 
"criminal  insanity,"  but  not  as  characteristic  of  solitary  confine- 
ment. This  opinion  was  also  supported  by  the  psychiatrists 
Kohler  and  Sommer,  and  later  by  Naecke.  It  is  conceivable  with- 
out further  comment  that  their  material  was  composed  almost 
exclusively  of  chronic  mental  disorders.  Their  studies  could  there- 
fore only  form  a  contribution  to  the  knowledge  of  the  forms  of 
dementia  precox  occurring  in  prison ;  an  explanation  of  the  prison 
psychoses  in  their  entirety  from  the  limited  character  of  the  mate- 
rial examined  is  not  to  be  expected.  That  their  descriptions  also 
in  part  deviate  greatly  from  actuality,  must  be  referred  to  their 
attempt  to  consider  dementing  processes  psychologically,  as  is  par- 
ticularly evident  in  the  work  of  Som  ler.  We  will  always  owe  to 
these  researches  the  knowledge  that  .'tIs  "criminal  insanity"  de- 
scribed by  Delbriick  is  only  a  characte  stic  disease  of  prison  in  so 
far  that  the  imprisonment  determines  :s  peculiar  form  and  con- 
tent, but  that  a  casual  connection  betw  ;en  prison  and  psychosis 
does  not  exist.  Sander  and  Richter  present  the  same  opinion  in 
their  well  known  monographs  on  the  rela'ion  of  mental  disturb- 
ances to  crime. 

The  work  of  Kirn  shows  a  significant  idvancement  over  that 
which  preceded  it.  His  observations  are  tased  upon  the  inmates 
of  the  county  jail  at  Freiberg,  who  during'  their  short  imprison- 


74  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

ment  became  ill,  therefore,  a  material  in  which  along  with  the 
chronic,  many  acute  psychoses  were  represented.  A  fundamental 
psychiatric  training  and  an  active  interest  in  our  questions  per- 
mitted Kirn  during  many  years'  observations  to  segregate  from 
the  recognized  forms  of  psychoses  those  which  occur  in  imprison- 
ment. As  we  previously  have  shown,  Kirn  described  two  pro- 
gressive delusional  forms  which  lead  to  deterioration.  The  one 
develops  gradually  on  the  basis  of  moral  imbecility,  the  other 
originates  acutely  on  untainted  soil.  The  first  is  identified  by 
Kirn  with  the  paranoia  of  the  criminal  (Verbrecherwahnsinn)  of 
Delbriick  and  the  prison  paranoia  (Gefangenwahnsinn)  of  Som- 
mer;  he  himself  describes  it  under  the  old  name  of  paranoia  of 
the  criminal  (Verbrecherwahnsinn),  in  contrast  to  the  second  form 
which  he  calls  the  prison  paranoia.  Besides  these  two  chronic 
types.  Kirn  separates  two  acute  specific  prison  psychoses:  the 
acute  hallucinatory  melancholia,  and  the  acute  hallucinatory  para- 
noia related  to  it  through  various  transitions.  The  acute  hallu- 
cinatory melancholia  was  to  Kirn  a  symptom-complex  sharply  dif- 
ferentiated from  melancholia  simplex.  This  frequently  occurs  in 
free  life  but  is  rare  in  prison;  this  resembles  the  simple  depression 
of  the  manic-depressive  psychosis  and  thus  the  observations  of 
Kirn  correspond  to  the  experiences  of  recent  authors  in  regard 
to  the  rarity  of  the  occurrence  of  manic-depressive  insanity  in 
prison.  The  acute  hallucinatory  melancholia  on  the  contrary  is 
a  rare  disease  in  freedom ;  it  is  like  the  acute  hallucinatory  para- 
noia, a  characteristic  psychosis  of  solitary  confinement.  Both  of 
these  disorders  contain  the  nucleus  of  those  acute  depressions 
which  Gutsch  has  described  as  the  melancholia  of  solitary  con- 
finement. Kirn  was  able  to  differentiate  them  sharply  from 
the  extremely  similar  disturbances  even  if  he  could  not  dif- 
ferentiate the  acute  hallucinatory  paranoia  from  the  symptom- 
complexes  which  introduced  the  prognostically  unfavorable  chronic 
prison  psychoses.  Kirn  was  consequently  the  first  who  sought  to 
differentiate  sharply  between  progressively  dementing  processes 


CONCLUSIONS  75 

and  acute  curable  psychoses.  That  he  succeeded  in  making  this 
differentiation  in  most  cases  is  learned  from  the  catamnestic  ob- 
servations of  his  cases  made  by  Homburger.  In  the  description 
of  the  paranoia  of  the  criminal  (Verbrecherwahnsinn)  we  again 
recognize  those  forms  of  dementia  precox  which  develop  slowly 
in  psychopathic  habitual  criminals,  and  in  the  chronic  prison  psy- 
choses, those  which  develop  acutely  on  a  not  demonstrably  de- 
fective basis.  The  description,  however,  which  Kirn  has  given 
of  the  acute  hallucinatory  melancholia  and  of  hallucinatory  para- 
noia leaves  no  doubt  that  fundamentally  these  rest  upon  degenera- 
tive prison  psychoses.  Although  Kirn  came  much  nearer  to  the 
present  opinion  in  regard  to  the  prison  psychoses  than  any  of  his 
predecessors,  his  opinions  did  not  become  current  and  were  ac- 
tively opposed  by  later  workers.  The  independence  of  both  of  the 
acute  solitary  confinement  psychoses  described  by  him  has  been 
attacked.  Kiihn  maintained  that  he  had  observed  the  same  symp- 
tom-complexes in  free  people  and  saw  in  them  merely  an  episode 
in  a  chronic  disease.  This  standpoint  is  understood  if  we  mention 
that  his  observations  were  made  on  fundamentally  mentally  dis- 
eased reform  school  inmates,  and  that  as  the  later  observations  of 
Wilmanns  showed,  the  degenerative  psychoses  are  much  less  fre- 
quent among  reform  school  inmates  than  dementia  precox. 

Naecke  was  like  Kiihn  unable  to  agree  with  the  teachings  of 
Kirn,  inasmuch  as  he  brought  forth  the  same  arguments  against 
him  on  the  ground  of  his  investigations  conducted  among  the  in- 
mates of  a  county  insane  asylum. 

The  importance  of  the  study  of  Reich  of  the  acute  psychic  dis- 
turbances during  imprisonment,  appearing  in  1871,  remained  with- 
out influence  upon  all  the  previously  mentioned  works.     In  tb 
he  describes  a  number  of  persons  who  as  a  result  of  the  intf 
impression  upon  the  emotions,  caused  by  a  short  sentence  f 
imprisonment  while  awaiting  trial,  developed  a  very  acute 
disturbance  from  which  they  recovered  after  a  few  hoi     j-pcrord 


y^  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

the  latest  a  few  weeks.  Characteristic  for  this  psychosis^  was  a 
kind  of  psychic  inhibition,  an  increasing  clouding  of  consciousness, 
the  development  of  the  psychic  activity  into  an  hallucinatory 
dream-life  and  the  amnesia  after  the  disappearance  of  the  disor- 
der. These  signs,  as  well  as  the  tendency  of  the  patient  to  con- 
vulsive seizures,  led  Reich  to  place  these  psychoses  developing  in 
prisoners  awaiting  trial,  in  that  large  group  of  psychically  abnor- 
mal processes  which  develop  from  affects  and  in  affect-like  condi- 
tions. In  spite  of  the,  for  that  time,  very  excellent  casuistic 
material,  the  observations  of  Reich  fell  into  oblivion  and  it  is  also 
a  decided  defect  in  Kirn's  work  that  he  does  not  give  enough  con- 
sideration in  his  descriptions  to  the  clouding  of  consciousness  and 
the  amnesias. 

The  work  of  Reich  remained  at  first  the  only  one  which  took 
account  of  the  psychoses  in  prisoners  awaiting  trial.  It  was  not 
until  1888  that  Moeli  called  attention  to  that  peculiar  symptom- 
complex,  which  up  to  that  time  had  been  frequently  described  in 
the  literature  on  simulation.  It,  however,  required  the  work  of 
Ganser,  whose  name  is  since  then  closely  connected  with  this  con- 
dition, in  order  to  make  it  known  to  a  wider  circle.  Ganser  inten- 
sified the  sketched  picture  of  Moeli,  he  pointed  out  the  dream-like 
clouding  of  consciousness  and  the  greater  or  lesser  loss  of  memory 
for  occurrences  during  this  confusion,  and  the  hysterical  stigmata, 
and  considers  the  disturbance  as  a  hysterical  twilight  state.  In 
spite  of  the  marked  difference,  the  close  relation  existing  between 
the  Ganser  twilight  state  and  the  acute  mental  disturbance  of 
Reich  is  apparent. 

The  work  of  Ganser  called  forth  a  number  of  publications 
upon  the  same  disease  picture,  among  which  that  of  Raecke's  is 

^  That  the  acute  psychoses  were  known  to  the  narrower  Illenau  school 
->ng  before  the  appearance  of  Reich's  paper  is  shown  by  the  comments  of 
ler  upon  the  opinions  of  Gutsch  on  the  melancholia  of  solitary  con- 
^'■>ent,  whom  he  advises  to  give  more  careful  attention  to  "  the  condi- 
pris  consciousness  during  and  after  these  attacks  and  to  the  coexisting 
diffe  ^nd  psychical  states." 


CONCLUSIONS  77 

to  be  particularly  mentioned.  Besides  the  important  works  on 
the  Ganser  twilight  state,  we  owe  to  him  the  description  of  the 
hysterical  stupor  in  prisoners,  a  disease  picture  which  is  closely 
related  to  and  through  transitions  associated  with  it,  which  also 
had  its  forerunners  in  certain  descriptions  of  Reich.  It  is  to 
Raecke's  credit  to  have  shown  the  susceptibility  to  outside  influ- 
ences and  ephemeral  character  of  these  disease  symptoms  and  to 
have  pointed  out  the  characteristics  in  the  dififerential  diagnosis 
from  catatonia.  Thus  to  the  critical  and  unprejudiced  judge  of 
the  first  period  of  the  literature  on  these  mental  disturbances, 
which  either  because  of  their  mode  of  genesis  or  their  symptoma- 
tology stood  in  close  relation  to  prison,  became  known :  firstly,  the 
chronic  psychoses,  which  develop  either  on  the  basis  of  a  criminal 
predisposition  (Verbrecherwahnsinn,  Kirn)  or  upon  a  not  demon- 
strably abnormal  predisposition  (Gefangnisswahnsinn,  Kirn), 
further,  acute  psychoses  with  a  favorable  prognosis, — the  acute 
mental  disturbances  in  prison  (Reich),  the  melancholia  halhici- 
natoria  acuta  (Kirn),  the  paranoia  hallucinatoria  acuta  (Kirn), 
the  Moeli-Ganser  symptom-complex,  the  Raecke  stupor,  and  finally, 
the  litigious  paranoia  (Querulantenwahnsinn),  which  according  to 
Kim  and  Kraepelin,  also  owes  its  origin  to  the  prison  influence  in 
many  cases. 

The  consideration  of  the  prison  psychoses  from  the  standpoint 
of  Kraepelin's  teachings  of  dementia  precox,  characterizes  the 
second  period.  Kraepelin's  opinions  in  regard  to  the  prison  psy- 
choses had  their  forerunners  firstly  in  Delbriick;  later  Sommer, 
Kiihn,  and  Naecke  had  expressly  shown  that  those  independent 
disease  pictures  described  by  Gutsch  and  Kim  were  only  episodes 
in  a  disease  with  a  symptomatology  phenomenally  protean  in  its 
manifestations.  Nevertheless  the  investigation  of  the  prison  psy- 
choses from  new  standpoints  showed  a  decided  advancement. 
Riidin  has  the  credit  of  being  the  first  to  have  shown  with  par- 
ticular exactness  that  all  psychoses  occurring  in  prison  (to  be  more 
correct,  almost  all,  as  our  knowledge  up  to  the  present  in  regard 


78  THE    HISTORY   OF   THE   PRISON    PSYCHOSES 

to  paresis  is  uncertain)  under  the  influence  of  the  particular 
milieu,  receive  a  characteristic  appearance  and  because  of  the  de- 
velopment of  this  "  prison  complex  "  can  show  a  certain  outward 
resemblance.  Wilmanns  showed  by  a  number  of  thorough  life 
histories  of  insane  tramps  what  influence  upon  the  life  of  these 
patients  is  exerted  particularly  by  the  slowly  developing  forms 
of  dementia  precox,  and  that  a  part  of  the  diseases  previously  char- 
acterized as  paranoia  of  the  criminal  (Verbrecherwahnsinn)  and 
the  paranoia  of  the  imprisoned  (Gefangenenwahnsinn)  were  only 
exacerbations  of  already  existing  disease  processes.  But  without 
mistaking  the  advancement  which  was  added  to  the  knowledge  of 
the  prison  psychoses  during  this  period,  on  the  other  hand,  we 
cannot  deny  that  the  wide  limits  of  dementia  precox  as  well  as  the 
overestimation  of  the  diagnostic  significance  of  the  so-called  cata- 
tonic symptom  must  have  brought  about  an  undoubted  superficiality 
of  observation  and  hastiness  in  judgment  of  the  cases.  The  result 
of  this  was  that  the  value  of  the  works  of  Reich,  Kirn,  Ganser 
and  others  were  underestimated  or  overlooked. 

The  two  mentioned  works  represent  the  second  period.  The 
contributions  of  Skliar,  Monkemoller  and  Hoffmann  arrange  them- 
selves only  temporarily  in  this  period ;  they  belong  so  far  as  their 
content  is  concerned  more  in  the  first  period. 

Riidin  in  his  first  work  covering  the  Heidelberg  material  con- 
tested the  existence  of  a  specific  prison  psychosis.  On  the  ground 
of  his  later  observation  at  Moabit,  he  believes  that  he  found  in 
several  cases  of  acute  hallucinatory  persecutory  delirium  (Verfol- 
gungswahn)  without  further  systematization  or  correction,  a  defi- 
nite independent  prison  psychosis.  Also  other  investigators,  who, 
following  in  principle  the  opinions  of  Kraepelin,  found  that  the 
prison  could  produce  symptom-complexes  which  cannot  be  classi- 
fied under  the  types  of  the  Kraepelin  school.  They  again  became 
conscious  of  transient  disorders  which  develop  in  hysterical  per- 
sons during  imprisonment  and  had  to  acknowledge  the  accuracy 
of  earlier  observations,  especially  the  descriptions  of  Ganser  and 
Raecke. 


CONCLUSIONS  79 

It  remained  for  the  third  period  finally  to  bring  greater  clear- 
ness to  the  subject  of  the  prison  psychoses.  It  is  characterized  by 
the  fruitful  Magnan-Mobius  ideas  on  degeneracy  in  their  applica- 
tion to  the  clinical  evaluation  of  this  group  of  psychoses.  Quite 
simultaneously  and  more  or  less  independently  of  one  another,  the 
adherents  of  the  various  schools  came  to  the  opinion  expressed  by 
Reich  when  he  brought  the  acute  mental  disturbances  in  prison 
into  connection  with  the  psychoses  which  develop  in  abnormal  per- 
sons on  the  basis  of  affective  disturbances.  Through  the  support 
of  the  teachings  on  degeneracy  it  was  established  that  the  majority 
of  the  prison  psychoses  are  not  of  pure  endogenous  origin  but 
rather  reach  their  development  from  the  reciprocal  effect  of  the 
psychically  diseased  constitution  and  the  manifold  physical  and 
psychic  traumata  of  prison.  While  the  earlier  observers  only 
made  mental  deterioration  the  object  of  their  studies  and  consid- 
ered the  original  personality  of  the  patients  in  all  cases  from  the 
standpoint  of  their  criminal  life  and  their  criminal  act  (criminal 
by  passion  or  habitual  criminals),  there  now  appeared  in  the  fore- 
ground the  relation  between  the  original  predisposition  and  the 
psychoses  and  the  previously  neglected  study  of  the  abnormal 
predispositions  was  given  particular  consideration. 

Siefert  was  the  first  to  publish  his  observations.  He  placed 
the  acute  psychoses  which  arose  and  grew  from  inner  causes  oppo- 
site the  degenerative  which  were  the  products  of  predisposition 
and  outside  influence.  The  sharp  separation  of  disease  groups 
which  were  never  definitely  differentiated  by  previous  contributors 
to  the  subject,  i.  e.,  juvenile  deteriorating  processes,  which  engraft 
themselves  as  a  foreign  element  upon  the  personality  and  which 
themselves  often  outwardly  resemble  degenerative  psychoses,  but 
which  represent  merely  abnormal  reactions  and  intensifications  of 
abnormal  predispositions,  necessarily  had  a  stimulating  and  clari- 
fying influence.  In  several  points,  the  differentially  diagnostic 
symptoms  of  these  groups  of  psychoses  are  certainly  laid  down 
too  dogmatically  and  their  significance  overestimated.     In  con- 


80  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

trast  with  earlier  investigators  in  this  field  who  unanimously  had 
assumed  that  the  demential  processes  were  instituted  by  the  im- 
prisonment and  that  their  development  could  be  checked  by  the 
interruption  of  the  imprisonment  at  the  proper  time,  Siefert  stated 
with  emphasis  that  they  were  of  purely  endogenous  origin  and 
were  uninfluenced  by  a  change  of  milieu.  While  Riidin  had 
shown  that  the  prison  influence  gave  a  characteristic  coloring  to 
each  disease  occurring  in  prison,  Siefert  thought  that  the  symp- 
tomatology of  the  true  psychoses  could  be  influenced  but  little  by 
the  surroundings.  The  result  of  these  preconceived  ideas,  as  well 
as  the  overestimation  of  the  differentially  diagnostic  significance 
of  certain  symptoms  which  are  quite  characteristic  of  the  psy- 
choses of  degeneracy  in  general,  was  a  more  frequent  failure  in 
recognizing  the  demential  processes.  Also,  in  his  general  concep- 
tion that  habitual  criminaHty  rests  upon  a  markedly  degenerative 
predisposition  and  that  the  degenerative  prison  psychosis  to  a  cer- 
tain extent  represents  a  reaction  of  the  disease  potentiality  and 
permits  of  a  social  prognosis,  Siefert  doubtless  overshot  the  mark 
as  is  indicated  by  the  catamnestic  researches  of  Homburger. 
However,  these  exaggerations  do  not  invalidate  the  great  worth 
of  his  work,  Siefert  had  already  mentioned  the  transitional  char- 
acter of  the  numerous  forms  of  the  degenerative  mental  disorders 
and  limited  himself  in  the  arrangement  of  his  material  to  setting 
up  solely  well  recognized  groups. 

Bonhoffer  sought  to  isolate  delimited  types  from  the  great 
variety  of  degenerative  psychoses ;  the  acute  paranoia  as  a  simple 
paranoid  reaction  on  the  basis  of  debility,  the  chronic  paranoia  as 
a  pathological  intensification  of  an  existing  predisposition,  the 
original  paranoia  owing  its  origin  to  the  lability  of  the  ego. 

Wilmanns  differentiated  the  acute  reactions  on  the  basis  of 
degeneracy  and  those  gradually  developing  states  on  abnormal  pre- 
dispositions and  sought  to  prove  the  existence  of  both  of  these 
groups  by  describing  isolated  types. 

These  contributions  were  made  more  profound  by  the  most 


CONCLUSIONS  8 1 

excellent  researches  of  Birnbaum.  These  Hniit  themselves  essen- 
tially to  a  group  of  degenerative  psychoses  which  are  closely  related 
to  those  described  by  Bonhofifer  as  original  paranoia,  a  type  of 
abnormal  personality  which  is  characterized  by  an  extreme  auto- 
suggestibility,  by  the  lability  of  the  momentarily  existing  psychotic 
states,  by  the  disproportionate  preponderance  of  active  phantasy 
over  sober  thought,  and  in  which  there  develops  in  prison  ex- 
tremely variable,  contradictory,  superficial  and  easily  influenced 
psychotic  symptoms  of  most  varied  kinds. 

Riidin  showed  in  his  instructive  case  histories  that  the  common 
ending  influenced  the  symptomatology  of  dementia  precox  and 
the  degnerative  psychoses  of  life  prisoners  in  a  similar  manner. 
Aside  therefrom  his  descriptions  form  a  noteworthy  supplement 
to  the  observations  of  Birnbaum.  We  see  that  these  patients  who, 
in  the  finality,  fixity,  and  slight  susceptibility  to  influence  of  the 
disease  symptoms,  stand  in  direct  contrast  to  the  cases  of  Birn- 
baum, and  who  appear  to  form  a  part  of  the  decidedly  uncommon 
chronic  psychogenic  disease  forms,  throw  an  interesting  light  upon 
the  position  of  certain  psychoses  of  free  life. 

Thus  the  third  period  in  the  study  of  the  prison  psychoses 
means  a  decided  advancement,  not  only  in  the  knowledge  of  this 
particular  group  of  psychoses,  but  further,  they  afford  a  new  view- 
point for  the  answer  to  the  questions  of  general  psychopathology 
and  the  consideration  of  certain  diseases  of  free  life.  The  long 
contention  concerning  the  question  of  a  specific  prison  psychosis 
was  determined  in  so  far  that  the  juvenile  demential  processes 
which  happen  to  develop  in  prison  obtain  only  a  characteristic  col- 
oring from  the  prison  milieu  and  that  in  suitably  organized  per- 
sonalities acute  and  chronic  psychoses  can  develop,  which  may  be 
placed  alongside  of  those  developing  in  these  persons  in  free  life 
under  the  influence  of  strongly  affective  experiences.  The  pecu- 
liar symptomatology  of  these  psychoses  justifies  us  in  consider- 
ing them  as  especial  types,  well  differentiated  from  those  devel- 
oping in   free  life.      From  this  viewpoint,  we  may  bring  them 


82  THE    HISTORY   OF   THE    PRISON    PSYCHOSES 

together  as  especial  prison  psychoses,  just  as  we  describe  under 
the  collective  term  "traumatic  neuroses "  those  very  numerous 
individual  reactions  and  developments  which  we  observe  in  free 
life  as  the  immediate  and  mediate  results  of  accidents.  However, 
as  among  these  it  is  possible  to  establish  various  types  according 
to  the  ground  on  which  the  disease  developed  and  according  to 
whether  the  shock  accompanying  the  accident,  the  inefficient  med- 
ical treatment,  or  the  suit  for  damages,  were  especially  potent  in 
producing  the  disorder,  just  so  would  a  deeper  investigation  of 
the  prison  psychoses  place  us  in  a  position  both  to  settle  upon  the 
characteristic  types  and  their  relations  to  the  original  personality 
of  the  patient  and  also  to  have  a  more  fundamental  conception  of 
their  symptomatology.  A  more  exact  knowledge  of  these  psy- 
choses would  also  permit  gradually  a  greater  accuracy  in  the  limi- 
tation of  similar  symptom-complexes  which  we  frequently  see  as 
introductory  phases  of  the  juvenile  demential  processes.  The  final 
solution  of  this  problem  will  remain  for  those  who  can  intimately 
follow  the  slow  genesis  and  gradual  development  of  these  disturb- 
ances. The  prison  physicians  are  therefore  called  upon  to  rein- 
vestigate this  much  discussed  question  and  to  solve  as  far  as  they 
are  able  the  question  of  the  effect  of  various  kinds  of  imprison- 
ment upon  mental  health  or  whether  long  imprisonment  can  pro- 
duce diseases  leading  to  deterioration.  Their  problem  must  finally 
also  be  to  broaden  our  knowledge  of  the  mentally  disordered  crim- 
inals by  systematic  examinations  of  mentally  normal  criminals  and 
to  place  under  psychiatric  observation  the  various  categories  of 
life  term  and  shorter  imprisonments. 


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DEC     1  1961 
N0V2C     - 


ii      2  M  from  Ksceipt 


&■ 


JAN  2    1974 


m 

DEC  1 4  REC1 


DJOMEO  M\ll 


FEB  05  1988 


88 


Form  L9-30m-7,'56(C824s4)444 


Sill 


Qn 


iiiiiiiiiiiiimiiiii 

3  1158  01235  7 


'^^m^ 


\imm 


— 7\ 


Or 


